Magno-Pereira Vítor, Moutinho-Ribeiro Pedro, Macedo Guilherme
Gastrenterology Department, Hospital Central do Funchal, Madeira, Portugal.
Gastrenterology Department, Centro Hospitalar de São João, Faculty of Medicine of Porto University, Porto, Portugal.
Eur J Obstet Gynecol Reprod Biol. 2017 Dec;219:35-39. doi: 10.1016/j.ejogrb.2017.10.008. Epub 2017 Oct 8.
For many years, ERCP was avoided in pregnancy given the concerns regarding the adverse effects that, with special focus on radiation, could occur in the developing fetus. However, the postponement or rejection of ERCP in pregnant women, may lead to a higher risk for mother and fetus, especially when the indication is unequivocal, namely cholangitis, biliary pancreatitis and symptomatic choledocholithiasis.
This review aims to summarize the scarce literature on the subject in order to plan ERCP in pregnancy with the highest safety. The use of techniques that reduce radiation and increase the protection of pregnant women allow radiation levels far below the safety limits. We also discuss the various alternatives of ERCP without radiation. EUS can eliminate the need for ERCP with doubtful choledocholithiasis and plan the best approach in those with previous evidence. The possibility of performing "ERCP" with a linear echoendoscope uniquely under ultrasound control has been described. Conversely, the two-step strategy (initial sphincterotomy with stent placement without fluoroscopy and after delivery, ERCP with lithiasis extraction) proved to be safe obviating fluoroscopy. In conclusion, ERCP can be performed in pregnancy safely and effectively with minimal radiation or even no-radiation at all.
多年来，鉴于担心对发育中的胎儿可能产生包括辐射在内的不良影响，孕期一直避免进行内镜逆行胰胆管造影术（ERCP）。然而，孕妇推迟或拒绝接受ERCP，可能会增加母亲和胎儿的风险，尤其是在指征明确，即发生胆管炎、胆源性胰腺炎和有症状的胆总管结石时。
本综述旨在总结关于该主题的稀少文献，以便以最高安全性来规划孕期的ERCP。使用减少辐射并增强对孕妇保护的技术，可使辐射水平远低于安全限值。我们还讨论了无辐射的ERCP的各种替代方法。超声内镜检查（EUS）可在胆总管结石诊断存疑时无需进行ERCP，并为有既往证据者规划最佳方法。已经描述了仅在超声控制下使用线性超声内镜进行“ERCP”的可能性。相反，两步策略（最初在无荧光透视的情况下进行括约肌切开术并放置支架，分娩后进行取石的ERCP）被证明是安全的，无需荧光透视。总之，ERCP可以在孕期安全有效地进行，辐射最小甚至完全无辐射。
