Ersoz Galip, Turan Ilker, Tekin Fatih, Ozutemiz Omer, Tekesin Oktay
Section of Gastroenterology, Ege University School of Medicine, Bornova, 35100, Izmir, Turkey.
Surg Endosc. 2016 Jan;30(1):222-8. doi: 10.1007/s00464-015-4190-1. Epub 2015 Apr 4.
Endoscopic retrograde cholangiopancreatography (ERCP) is currently the treatment of choice for symptomatic choledocholithiasis in pregnant patients. We aimed to present our experience with pregnant patients who underwent nonradiation ERCP and to evaluate the safety and efficacy of a new technique.
A retrospective analysis of nonradiation ERCP in 22 pregnant patients with symptomatic choledocholithiasis between January 2002 and December 2013 was performed. The bile aspiration technique with wire-guided sphincterotome was used to confirm selective biliary cannulation. Transpapillary pancreatic septotomy was performed in cases with difficult biliary cannulation (n = 3). After endoscopic biliary sphincterotomy, endoscopic papillary balloon dilation was performed with a 6- or 8-mm dilation balloon in all patients to reduce the risk of recurrent cholangitis because of residual or additional stones. Stones were extracted by balloon sweeping after dilation. All patients were followed for 6 months after the ERCP procedure.
Biliary cannulation was achieved in all patients. Endoscopic papillary balloon dilation was performed with a 6-mm balloon in 17 patients and an 8-mm balloon in five patients. The stones were extracted in 18 of the 22 patients by balloon sweeping, but no stones were extracted in the remaining four patients. There were two cases of mild post-ERCP pancreatitis. All patients delivered at term, and none experienced recurrence of choledocholithiasis and/or cholangitis during the 6-month follow-up.
Endoscopic biliary sphincterotomy plus endoscopic papillary balloon dilation in nonradiation ERCP is a safe and effective treatment method for symptomatic choledocholithiasis during pregnancy.
内镜逆行胰胆管造影术（ERCP）目前是治疗妊娠合并症状性胆总管结石患者的首选方法。我们旨在介绍我们对接受非辐射性ERCP的妊娠患者的经验，并评估一种新技术的安全性和有效性。
对2002年1月至2013年12月期间22例有症状性胆总管结石的妊娠患者进行非辐射性ERCP的回顾性分析。采用导丝引导括约肌切开刀的胆汁抽吸技术来确认选择性胆管插管。对于胆管插管困难的病例（n = 3），进行经乳头胰管分隔切开术。在内镜下胆管括约肌切开术后，所有患者均使用6或8毫米扩张球囊进行内镜乳头球囊扩张，以降低因残留或额外结石导致复发性胆管炎的风险。扩张后通过球囊清扫取出结石。所有患者在ERCP术后随访6个月。
所有患者均成功实现胆管插管。17例患者使用6毫米球囊进行内镜乳头球囊扩张，5例患者使用8毫米球囊。22例患者中有18例通过球囊清扫取出结石，但其余4例患者未取出结石。有2例发生轻度ERCP术后胰腺炎。所有患者均足月分娩，在6个月的随访期间，无一例发生胆总管结石和/或胆管炎复发。
非辐射性ERCP中的内镜胆管括约肌切开术加内镜乳头球囊扩张术是治疗妊娠期症状性胆总管结石的一种安全有效的方法。
