Js. Barthel et al., ENDOSCOPIC SPHINCTEROTOMY FOR THE TREATMENT OF GALLSTONE PANCREATITISDURING PREGNANCY, Surgical endoscopy, 12(5), 1998, pp. 394-399
Background: Gallstones are the most common cause of acute pancreatitis
during pregnancy. Without intervention, gallstone pancreatitis during
pregnancy is associated with an antepartum recurrence rate of 70%, wh
ich exposes the mother and fetus to an increased risk of morbidity and
mortality, A safe, effective means to prevent recurrent gallstone pan
creatitis during pregnancy is desirable.Methods: Since 1991, we have m
anaged gallstone pancreatitis in three pregnant patients with endoscop
ic retrograde cholangiogram (ERC), followed by spincterotomy, despite
the absence of common bile duct stones. Results: All patients were jud
ged to have mild pancreatitis by modified Ranson criteria and the Mult
iorgan System Failure criteria. During cholangiogram, fetal shielding
was employed and fluoroscopy times ranged from 36 s to 7.2 min. One pa
tient experienced postprocedure pancreatitis of 48-h duration. None of
the patients experienced further episodes of pancreatitis and none un
derwent predelivery cholecystectomy. Conclusions: In pregnancy-associa
ted gallstone pancreatitis, endoscopic sphincterotomy prevents recurre
nce of pancreatitis and the need for cholecystectomy during gestation.
We believe endoscopic sphincterotomy represents a promising managemen
t alternative for gallstone pancreatitis during pregnancy. Further inv
estigation is warranted.