Department of Gastroenterology and Hepatology, Loma Linda University Medical Center, California, USA.
Department of Gastroenterology, University of Nevada Las Vegas, Las Vegas, Nevada, USA.
Saudi J Gastroenterol. 2019 Nov-Dec;25(6):341-354. doi: 10.4103/sjg.SJG_92_19.
BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is a technically challenging procedure rarely associated with severe postprocedure complications. Hormonal changes during pregnancy promote cholelithiasis, but there are limited clinical data available on the outcomes of ERCP in pregnant women. ERCP techniques without irradiation were recently introduced as potential alternative. We performed a systematic review and meta-analysis to assess the safety of ERCP in pregnancy and to compare outcomes of radiation versus nonradiation ERCP. MATERIALS AND METHODS: A systematic search of PubMed, Medline/Ovid, Web of Science, and Google Scholar through April 18, 2018 using PRISMA and MOOSE guidelines identified 27 studies reporting the outcomes of ERCP in pregnancy. Random effects pooled event rate and 95% confidence intervals (CIs) were estimated. Heterogeneity was measured by I, and meta-regression analysis was conducted. Adverse outcomes were divided into fetal, maternal pregnancy-related, and maternal nonpregnancy-related. RESULTS: In all, 27 studies reporting on 1,307 pregnant patients who underwent ERCP were identified. Median age was 27.1 years. All results were statistically significant (P < 0.01). The pooled event rate for overall adverse outcomes was 15.9% (95% CI = 0.132-0.191) in all studies combined, 17.6% (95% CI = 0.109-0.272) in nonradiation ERCP (NR-ERCP) subgroup and 21.6% (95% CI = 0.154-0.294) in radiation ERCP subgroup. There was no significant difference in the pooled event rate for fetal adverse outcomes in NR-ERCP 6.2% (95% CI = 0.027-0.137) versus 5.2% (95% CI = 0.026-0.101) in radiation ERCP group. There was no significant difference in maternal pregnancy-related adverse outcome event rate between NR-ERCP (8.4%) (95% CI = 0.038-0.173) and radiation ERCP (7.1%) (95% CI = 0.039-0.125). Maternal nonpregnancy-related adverse outcome event rate in NR-ERCP was 7.6% (95% CI = 0.038-0.145), which was half the event rate in radiation ERCP group of 14.9% (95% CI = 0.102-0.211). CONCLUSIONS: ERCP done by experienced endoscopists is a safe procedure during pregnancy. Radiation-free techniques appear to reduce the rates of nonpregnancy-related complications, but not of fetal and pregnancy-related complications.
背景/目的：内镜逆行胰胆管造影术（ERCP）是一项技术要求较高的操作，很少与严重的术后并发症相关。妊娠期间激素变化可导致胆石症，但关于孕妇 ERCP 结局的临床数据有限。最近，无辐射的 ERCP 技术被作为潜在的替代方法推出。我们进行了一项系统综述和荟萃分析，以评估 ERCP 在妊娠期间的安全性，并比较辐射与非辐射 ERCP 的结果。 材料和方法：通过 PRISMA 和 MOOSE 指南，系统地搜索了 PubMed、Medline/Ovid、Web of Science 和 Google Scholar 数据库，检索时间截至 2018 年 4 月 18 日，共确定了 27 项报道妊娠期间 ERCP 结局的研究。使用随机效应模型估计了总体不良事件的发生率和 95%置信区间（CI）。采用 I²衡量异质性，并进行了荟萃回归分析。不良结局分为胎儿、妊娠相关母体和非妊娠相关母体。 结果：共确定了 27 项报道了 1307 例接受 ERCP 孕妇的研究。中位年龄为 27.1 岁。所有结果均具有统计学意义（P<0.01）。所有研究合并的总体不良结局发生率为 15.9%（95%CI=0.132-0.191），非辐射 ERCP（NR-ERCP）亚组为 17.6%（95%CI=0.109-0.272），辐射 ERCP 亚组为 21.6%（95%CI=0.154-0.294）。NR-ERCP 的胎儿不良结局发生率为 6.2%（95%CI=0.027-0.137），与辐射 ERCP 组的 5.2%（95%CI=0.026-0.101）无显著差异。NR-ERCP 的妊娠相关母体不良结局发生率为 8.4%（95%CI=0.038-0.173），与辐射 ERCP 组的 7.1%（95%CI=0.039-0.125）无显著差异。NR-ERCP 的非妊娠相关母体不良结局发生率为 7.6%（95%CI=0.038-0.145），为辐射 ERCP 组的一半，为 14.9%（95%CI=0.102-0.211）。 结论：由经验丰富的内镜医生进行的 ERCP 在妊娠期间是一种安全的操作。无辐射技术似乎降低了非妊娠相关并发症的发生率，但并未降低胎儿和妊娠相关并发症的发生率。
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