ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN PREGNANCY

Background: Pancreaticobiliary disease in pregnancy is relatively unco mmon. The frequency of choledocholithiasis in pregnancy requiring inte rvention has been reported to be as low as one in 1200 deliveries. Tra ditionally, intervention in these patients has been surgical. Although surgery has an overall low morbidity and mortality for the expectant mother, it carries with it a 4- to 6-wk recovery period and a possibly increased risk of fetal wastage. Published information regarding the role and safety of ERCP in pregnancy is limited. This series of 23 pre gnant patients undergoing ERCP was collected from six different medica l centers. Methods: Twenty-three pregnant patients with symptomatic pa ncreaticobiliary disease underwent a total of 29 ERCPs (three patients had diagnostic ERCP, and 20 had therapeutic ERCP). Fifteen, eight, an d six procedures were performed in the first, second, and third trimes ters, respectively. The only ERCP complication was pancreatitis in one patient. There was one spontaneous abortion (3 months after ERCP) and one neonatal death; however, casual relationship to ERCP was not appa rent. Conclusion: Diagnostic and therapeutic ERCP appears reasonably s afe and effective in pregnancy. Cautious and selective use of this pro cedure offers a viable alternative to surgery or observation in patien ts with emergent pancreaticobiliary problems.