Efficacy and Safety of Pancreatobiliary Endoscopic Procedures during Pregnancy
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background/Aims: Endoscopic therapy with endoscopic retrograde cholangiopancreatography (ERCP) has been suggested as an effective diagnostic and therapeutic tool for biliary and pancreatic disorders during pregnancy. In this report, we describe our experiences with pancreatobiliary endoscopic procedures during pregnancy. Methods: We reviewed ERCP and endoscopic ultrasonography (EUS) procedures that were performed at a single tertiary care referral center between January 2002 and October 2013. Medical records were reviewed for the procedure indication, the duration of fluoroscopy, postprocedure complications, etc. Pregnancy outcomes and fetal complications were identified by chart review and phone calls to patients. Results: A total of 10 ERCPs and five EUSs were performed in 13 pregnant patients: four of whom underwent the procedure in the first trimester, eight in the second trimester, and one in the third trimester. Indications for endoscopic therapy included gallstone pancreatitis, obstructive jaundice with common bile duct (CBD) stone, asymptomatic CBD stone, pancreatic cyst, choledochal cyst, and acute cholecystitis. Only one patient had a complication, which was postprocedural hyperamylasemia. Two patients underwent an artificial abortion, one according to her own decision and the other due to an adverse drug reaction. Conclusions: ERCP seems to be effective and safe for pregnant women. Additionally, EUS can be an alternative to ERCP during pregnancy.
Abstract
Background/Aims: Endoscopic therapy with endoscopic retrograde cholangiopancreatography (ERCP) has been suggested as an effective diagnostic and therapeutic tool for biliary and pancreatic disorders during pregnancy. In this report, we describe our experiences with pancreatobiliary endoscopic procedures during pregnancy. Methods: We reviewed ERCP and endoscopic ultrasonography (EUS) procedures that were performed at a single tertiary care referral center between January 2002 and October 2013. Medical records were reviewed for the procedure indication, the duration of fluoroscopy, postprocedure complications, etc. Pregnancy outcomes and fetal complications were identified by chart review and phone calls to patients. Results: A total of 10 ERCPs and five EUSs were performed in 13 pregnant patients: four of whom underwent the procedure in the first trimester, eight in the second trimester, and one in the third trimester. Indications for endoscopic therapy included gallstone pancreatitis, obstructive jaundice with common bile duct (CBD) stone, asymptomatic CBD stone, pancreatic cyst, choledochal cyst, and acute cholecystitis. Only one patient had a complication, which was postprocedural hyperamylasemia. Two patients underwent an artificial abortion, one according to her own decision and the other due to an adverse drug reaction. Conclusions: ERCP seems to be effective and safe for pregnant women. Additionally, EUS can be an alternative to ERCP during pregnancy.
참고문헌 (26)
- Tang SJ, "Safety and utility of ERCP during pregnancy", Gastrointest Endosc, 69(3), pp.453~461 (2009)
- Brent RL, "The effect of embryonic and fetal exposure to x-ray, microwaves, and ultrasound: counseling the pregnant and nonpregnant patient about these risks", Semin Oncol, 16, pp.347~368 (1989)
- Cunningham FG, "Williams obstetrics", pp.1143~1158 (2001), McGraw-Hill
- Hall EJ, "Scientific view of low-level radiation risks", Radiographics, 11, pp.509~518 (1991)
- National Research Council, "Health effects of exposure to low levels of ionizing radiation: Beir V", pp.352~370 (1990), National Academy Press
- Valdivieso V, "Pregnancy and cholelithiasis: pathogenesis and natural course of gallstones diagnosed in early puerperium", Hepatology, 17, pp.1~4 (1993)
- Severe mental retardation among prenatally exposed survivors of the atomic bombing of Hiroshima and Nagasaki: a comparison of the T65DR and DS86 dosimetry systems, "Otake M", Radiation Effects Research Foundation, ~ (1988)
- International Commission on Radiological Protection, "Pregnancy and medical radiation", Ann ICRP, 30, pp.3~8 (2000)
- Samara ET, "Therapeutic ERCP and pregnancy: is the radiation risk for the conceptus trivial?", Gastrointest Endosc, 69, pp.824~831 (2009)
- Baron TH, "Pregnancy and radiation exposure during therapeutic ERCP: time to put the baby to bed?", Gastrointest Endosc, 69, pp.832~834 (2009)
- International Commission on Radiological Protection, "Pregnancy and medical radiation" (2000), Pergamon
- Tham TC, "Safety of ERCP during pregnancy", Am J Gastroenterol, 98, pp.308~311 (2003)
- Kahaleh M, "Safety and efficacy of ERCP in pregnancy", Gastrointest Endosc, 60, pp.287~292 (2004)
- Smith I, "Safety of endoscopic retrograde cholangiopancreatography in pregnancy: fluoroscopy time and fetal exposure, does it matter?", World J Gastrointest Endosc, 5, pp.148~153 (2013)
- Rahmin MG, "ERCP for symptomatic choledocholithiasis in pregnancy", Am J Gastroenterol, 89, pp.1601~1602 (1994)
- Zagoni T, "Endoscopic sphincterotomy without fluoroscopic control in pregnancy", Am J Gastroenterol, 90, pp.1028~ (1995)
- Yang J, "Therapeutic efficacy of endoscopic retrograde cholangiopancreatography among pregnant women with severe acute biliary pancreatitis", J Laparoendosc Adv Surg Tech A, 23, pp.437~440 (2013)
- Lee YT, "Comparison of EUS and ERCP in the investigation with suspected biliary obstruction caused by choledocholithiasis: a randomized study", Gastrointest Endosc, 67, pp.660~668 (2008)
- Reedy MB, "Laparoscopy during pregnancy: a survey of laparoendoscopic surgeons", J Reprod Med, 42, pp.33~38 (1997)
- Patel SG, "Laparoscopic cholecystectomy in pregnancy", Curr Surg, 59, pp.74~78 (2002)
- Abuabara SF, "Laparoscopic cholecystectomy during pregnancy is safe for both mother and fetus", J Gastrointest Surg, 1, pp.48~52 (1997)
- Glasgow RE, "Changing management of gallstone disease during pregnancy", Surg Endosc, 12, pp.241~246 (1998)
- Graham G, "Laparoscopic cholecystectomy during pregnancy: a case series and review of the literature", Obstet Gynecol Surv, 53, pp.566~574 (1998)
- Barone JE, "Outcome study of cholecystectomy during pregnancy", Am J Surg, 177, pp.232~236 (1999)
- Barthel JS, "Endoscopic sphincterotomy for the treatment of gallstone pancreatitis during pregnancy", Surg Endosc, 12, pp.394~399 (1998)
- Cappell MS, "The fetal safety and clinical efficacy of gastrointestinal endoscopy during pregnancy", Gastroenterol Clin North Am, 32, pp.123~179 (2003)