ENDOSCOPIC SPHINCTEROTOMY FOR THE TREATMENT OF GALLSTONE PANCREATITISDURING PREGNANCY

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.