Dahiya Dushyant Singh, Chandan Saurabh, Desai Aakash, Ramai Daryl, Mohan Babu P, Facciorusso Antonio, Bilal Mohammad, Sharma Neil R, Adler Douglas G, Kochhar Gursimran S
Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, KS, USA.
Division of Gastroenterology and Hepatology, Creighton University School of Medicine, 7710 Mercy Road, Suite 200, Omaha, NE, 68124, USA.
Dig Dis Sci. 2023 Nov;68(11):4266-4273. doi: 10.1007/s10620-023-08112-y. Epub 2023 Sep 24.
Studies have suggested higher complication rates after endoscopic retrograde cholangiopancreatography (ERCP) in pregnancy.
We performed a propensity-matched cohort analysis to assess the risk of ERCP-related complications among pregnant women in the United States.
The TriNetX database was analyzed to identify pregnant and non-pregnant females between 18 and 50 years of age who underwent ERCP. One-to-one propensity score matching was performed for age and race. Outcomes included risk of post-ERCP pancreatitis (PEP), gastrointestinal (GI) bleeding, perforation within 7 days, and infections within 30 days of ERCP. Subgroup analysis was performed to assess the risk of PEP based on indication for ERCP.
The risk of PEP was higher in the pregnant cohort compared to controls, 10.3% vs 6.08%, adjusted odds ratio (aOR) 1.77, 95% confidence interval (CI) 1.20-2.61; p = 0.003. We found no difference in the risk of GI bleeding, perforation, and infections between the two cohorts. There was no difference in the risk of PEP in the pregnant cohort compared to controls who underwent ERCP for acute choledocholithiasis (4.2% vs 2.1%, aOR 1.98, 95% CI 0.97-4.03, p = 0.5) or ascending cholangitis (18.6% vs 14.7%, aOR 1.32, 95% CI 0.52-3.39, p = 0.55). There was no difference in the risk of PEP in the pregnant cohort after sensitivity analysis based on age, race, obesity, and indomethacin use.
Pregnant females are at an increased risk of PEP but not GI bleeding, perforation, and infections when compared to non-pregnant controls. Clinicians should be cautious when proceeding with ERCP during pregnancy.
研究表明，孕期进行内镜逆行胰胆管造影术（ERCP）后并发症发生率更高。
我们进行了一项倾向匹配队列分析，以评估美国孕妇中ERCP相关并发症的风险。
分析TriNetX数据库，以识别年龄在18至50岁之间接受ERCP的孕妇和非孕妇。对年龄和种族进行一对一倾向评分匹配。结局包括ERCP后胰腺炎（PEP）、胃肠道（GI）出血、7天内穿孔以及ERCP后30天内感染的风险。基于ERCP的指征进行亚组分析，以评估PEP的风险。
与对照组相比，孕妇队列中PEP的风险更高，分别为10.3%和6.08%，调整后的优势比（aOR）为1.77，95%置信区间（CI）为1.20 - 2.61；p = 0.003。我们发现两组队列在GI出血、穿孔和感染风险方面没有差异。与因急性胆总管结石接受ERCP的对照组相比，孕妇队列中PEP的风险没有差异（4.2%对2.1%，aOR 1.98，95% CI 0.97 - 4.03，p = 0.5），与因化脓性胆管炎接受ERCP的对照组相比也没有差异（18.6%对14.7%，aOR 1.32，95% CI 0.52 - 3.39，p = 0.55）。在基于年龄、种族、肥胖和吲哚美辛使用情况进行敏感性分析后，孕妇队列中PEP的风险没有差异。
与非孕妇对照组相比，孕妇发生PEP的风险增加，但发生GI出血、穿孔和感染的风险没有增加。临床医生在孕期进行ERCP时应谨慎。
