Real-time transabdominal ultrasound-guided ERCP is feasible and effective in pregnancy: a case series

Abstract

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is commonly required in pregnancy for choledocholithiasis, however, radiation exposure is a major concern for patients. Real-time transabdominal (TA) ultrasound (US)-guided ERCP is a radiation-free technique that facilitates confirmation of biliary cannulation, equipment exchange and stone clearance. We present the largest Western case series of this modality in pregnancy and a review of the literature.Four pregnant adult patients were referred to our tertiary center with suspected or documented choledocholithiasis and underwent real-time TA US-guided ERCP. US was successfully used to confirm positioning of the guidewire and ductal clearance. Procedures were successful in all patients with resolution of clinical symptoms and no immediate procedural complications. Two patients suffered adverse events later in their pregnancy.Real-time TA US-guided ERCP is a technically feasible and effective modality that can be offered to obtain biliary access in a radiation-free fashion for specific subsets of pregnant patients with choledocholithiasis. Future studies are needed to confirm the safety of this technique.

Laparoscopic bile duct exploration during pregnancy: a multi-center case series and literature review

“…Another alternative management strategy to conventional ERCP is real-time transabdominal ultrasound guided ERCP. Li et al, described this approach in four pregnant adult patients with resolution of clinical symptoms but two patients suffered adverse events later in their pregnancy (29).…”

Choledocholithiasis in Pregnancy: A Case Report

“…Transabdominal US-guided non-radiation ERCP procedures for the removal of CBD stones during pregnancy have been demonstrated [19]. More studies are needed to assess its safety and efficacy.…”

“…Endoscopic ultrasound (EUS) provides an alternative (non-ionizing) means of imaging the CBD. Transabdominal US-guided non-radiation ERCP procedures for the removal of CBD stones during pregnancy have been demonstrated [ 19 ]. More studies are needed to assess its safety and efficacy.…”