Department of Digestive Diseases, Hospital Virgen de la Luz, Cuenca, Spain.
Rev Esp Enferm Dig. 2012 Feb;104(2):53-8. doi: 10.4321/s1130-01082012000200002.
ERCP during pregnancy is always challenging for the entire team performing the endoscopic intervention. In this study techniques and different interventional aspects used at several centres about the clinical experience on ERCP in pregnant women are analyzed.
the practice on ERCP in pregnant women in six centres during a period of ten years is reported.
eleven patients were included in the study. Mean age was 30.6 years. Indication for ERCP was always symptomatic common bile duct stone (CBDS) disease. Before the procedure abdominal ultrasound was performed at all times and magnetic resonance cholangiopancreatography in four occasions. Conscious sedation by means of midazolam and fentanyl or meperidine was applied. Sphincterotomes and guidewires were used for bilary cannulation. Sometimes, rapid exchange platforms with short-length guidewires controlled by the same endoscopist were employed. Biliary cannulation was confirmed in 9 occasions by bile aspiration. In five procedures, a mean of 30 seconds of fluoroscopy was used, both to verify cannulation and to corroborate complete CBDS clearance. These patients had the pelvic zone protected with a lead shield and radiation dose was measured. Ten biliary sphincterotomies were performed followed by CBDS extraction. Two plastic stents were inserted. Relief of biliary obstruction was attained in all circumstances. Only one patient had hyperamylasemia after ERCP. All pregnant women had healthy foetuses with normal deliveries.
with experience, ERCP appears to be a safe technique during pregnancy. With simple measures fluoroscopic time can be diminished or even abolished. It seems that ERCP during pregnancy is underused in our working areas, although it has shown to be a useful technique for relieving biliary obstruction.
ERCP 在孕期对于执行内镜介入的整个团队来说一直是一项挑战。在这项研究中，分析了几个中心在对孕妇进行 ERCP 时使用的技术和不同的介入方面，报告了在十个年头中在六个中心进行的孕妇 ERCP 实践经验。
研究纳入了 11 名患者。平均年龄为 30.6 岁。ERCP 的适应证始终为有症状的胆总管结石（CBDS）疾病。在术前，所有情况下均进行了腹部超声检查，4 次进行了磁共振胰胆管成像检查。采用咪达唑仑和芬太尼或哌替啶进行清醒镇静。使用括约肌切开刀和导丝进行胆管插管。有时，会使用带有短导丝的快速交换平台，由同一位内镜医生进行控制。在 9 次操作中，通过胆汁抽吸确认胆管插管。在 5 次操作中，平均使用 30 秒的透视来验证插管并确认 CBDS 完全清除。这些患者使用铅屏蔽保护骨盆区域，并测量辐射剂量。进行了 10 次胆道括约肌切开术，随后进行 CBDS 取出术。插入了两个塑料支架。所有情况下均成功缓解了胆道梗阻。只有 1 例患者在 ERCP 后出现高淀粉酶血症。所有孕妇均产下了健康的胎儿。
随着经验的积累，ERCP 在孕期似乎是一种安全的技术。通过简单的措施，可以减少甚至消除透视时间。尽管 ERCP 已被证明是缓解胆道梗阻的有用技术，但在我们的工作领域中，它似乎并未得到充分应用。
