Case studyCommitment, confirmation, and clearance: new techniques for nonradiation ERCP during pregnancy (with videos)
Section snippets
Patients and methods
Since November 2000, we have performed a therapeutic ERCP on 21 consecutive pregnant women without the use of fluoroscopy. During the study period, no pregnant patients underwent an ERCP with fluoroscopy, and no other pregnant women underwent a diagnostic ERCP. This study was approved by the Methodist Dallas Medical Center Institutional Review Board during July 2007.
A history and physical examination, laboratory studies, and imaging were used to determine the need for a therapeutic ERCP.
Results
An ERCP with sphincterotomy and removal of biliary stones (14 patients) or sludge (7 patients) was successfully performed without fluoroscopy in all 21 pregnant women. Of the 6 patients who underwent an EUS before an ERCP, 2 patients had bile-duct stones, and 4 patients had bile-duct sludge found on an EUS. Patient clinical data, method of biliary access, and complication outcomes are summarized in Table 1. The mean age of the patients was 27 years, and the mean gestation age was 19 weeks. All
Discussion
Symptomatic choledocholithiasis is a relatively common disorder during pregnancy and may have serious consequences if not treated. An ERCP can be therapeutic in this setting, and nonradiation ERCP may be preferable, because fluoroscopy carries a potential risk for the fetus. Nonradiation ERCP during pregnancy was first described by Binmoeller and Katon7 in 1990: a needle-knife papillotomy was performed to free an impacted ampullary stone. We previously reported the largest series at that time
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2019, International Journal of SurgeryCitation Excerpt :In addition, the radiation effect of fluoroscopy used during ERCP might be associated with teratogenicity. Therefore, alternative methods aiming to visualize the biliary tree by using radiation free ERCP techniques have been described in literature, like cholangioscopy, bile aspiration and endosocopic sonography [29,42–45]. Although these reports were generally based on single centre experiences that involved small number of patients, they could perhaps pave the way for larger future studies.
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2018, Gastrointestinal EndoscopyCitation Excerpt :This study establishes the feasibility of DSC as a fluoroscopy and radiation-free alternative, with success and adverse event rates similar to standard ERCP for the therapy of noncomplex bile duct stone disease. US-facilitated approaches for achieving fluoroscopy-free ERCP have been reported by our group and others.6-8,10 In a recent case series, EUS-assisted ERCP was attempted in 31 patients with choledocholithiasis, successfully in 84%.11
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