Successful single‐session endosonography‐based endoscopic retrograde cholangiopancreatography without fluoroscopy in pregnant patients with suspected choledocholithiasis: a case series

Vohra, Sheba; Holt, Edward W.; Bhat, Yasser M.; Kane, Steve; Shah, Janak N.; Binmoeller, Kenneth F.

doi:10.1002/jhbp.7

Cited by 25 publications

(22 citation statements)

References 15 publications

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“…first reported that EUS is a safe alternative to ERCP in the management of pregnant patients with gallstones. Since then, several studies have attempted to assess the usefulness of EUS‐guided ERCP in pregnant patients with suspected CBD stones . They used EUS to eliminate unnecessary interventions and its associated risks in patients with low or moderate probabilities for choledocholithiasis.…”

Section: Eus‐guided Ercpmentioning

confidence: 99%

“…The results of NR-ERCP during pregnancy in the published studies are summarized in (Table 1). [11][12][13][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] Indications for this procedure in these patients were cholecystolithiasis, choledocholithiasis, biliary pancreatitis, cholangitis and biliary fistula. The non-radiation technique was used in all trimesters of pregnancy.…”

Section: Efficacy Of Nr-ercp In the Published Literaturementioning

confidence: 99%

“…Since then, several studies have attempted to assess the usefulness of EUS-guided ERCP in pregnant patients with suspected CBD stones. 50,51,57 They used EUS to eliminate unnecessary interventions and its associated risks in patients with low or moderate probabilities for choledocholithiasis. In patients with a confirmed CBD stone, EUS provided information regarding the location, number and size of stones, 57 allowing a subsequent NR-ERCP procedure (bile aspirate) with endoscopic sphincterotomy and duct clearance.…”

Section: Eus-guided Ercpmentioning

confidence: 99%

“…In patients with a confirmed CBD stone, EUS provided information regarding the location, number and size of stones, 57 allowing a subsequent NR-ERCP procedure (bile aspirate) with endoscopic sphincterotomy and duct clearance. 57 The primary challenges to EUS-guided ERCP are technical and fiscal. EUS requires additional expensive equipment and expertise, and lengthens the procedure time.…”

Section: Eus-guided Ercpmentioning

confidence: 99%

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Non‐radiation endoscopic retrograde cholangiopancreatography in the management of choledocholithiasis during pregnancy

Faigel

Yang

2014

Digestive Endoscopy

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Gallstone diseases are common during pregnancy. In most cases, patients are asymptomatic and do not require any treatment. However, choledocholithiasis, cholangitis, and gallstone pancreatitis may potentially become life-threatening for both mother and fetus and often require urgent intervention. Although endoscopic retrograde cholangiopancreatography (ERCP) has become the standard technique for removing common bile duct stones, it is associated with ionizing radiation that could carry teratogenic risk. Non-radiation ERCP (NR-ERCP) is reported to be effective without incurring this risk. Two techniques have been described to confirm bile duct cannulation: bile aspiration and image guidance. With bile aspiration, biliary cannulation is confirmed by applying suction to the cannula to yield bile, thus confirming an intrabiliary position. Image guidance involves using ultrasound or direct visualization (choledochoscopy) to confirm selective biliary cannulation or duct clearance. Once cannulation is achieved, the stones are removed using standard ERCP techniques and tools. Case series and retrospective studies have reported success rates of up to 90% for NR-ERCP with complication rates similar to standard ERCP. Pregnancy outcomes are not adversely affected by NR-ERCP, but whether the avoidance of radiation carries benefit for the baby is unknown. Prospective comparative trials are lacking. NR-ERCP is technically demanding and should be attempted only by skilled biliary endoscopists in properly equipped and staffed health-care institutions, in a multidisciplinary setting.

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Section: Eus‐guided Ercpmentioning

confidence: 99%

Section: Efficacy Of Nr-ercp In the Published Literaturementioning

confidence: 99%

Section: Eus-guided Ercpmentioning

confidence: 99%

Section: Eus-guided Ercpmentioning

confidence: 99%

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Non‐radiation endoscopic retrograde cholangiopancreatography in the management of choledocholithiasis during pregnancy

Faigel

Yang

2014

Digestive Endoscopy

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“…Another interesting group of patients are pregnant women. Vohra et al [20] reported a successful single-session EUS-based ERCP in 10 pregnant patients with suspected choledocholithiasis. In this case series, EUS immediately prior to scheduled ERCP eliminated the need for ERCP and also its risks in pregnant women with no evidence of choledocholithiasis on EUS.…”

Section: Choledocholithiasismentioning

confidence: 99%

Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound: To Be One Traveler in Converging Roads

Moutinho-Ribeiro

Peixoto

Macedo³

2017

GE Port J Gastroenterol

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Background: Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) were initially introduced into the world of gastroenterology as purely diagnostic procedures. With progressive evolution of intervention, both these techniques conquered fields in the treatment of many conditions that had once been exclusively surgical domains. Nowadays, more and more clinical situations have an indication to perform both EUS and ERCP, and these two techniques are frequently required at the same time for the same patient. More than competitors, ERCP and EUS are truly complementary, with great ability for mutual aid. They share their main indications, equipment, accessories, and main technical gestures. Objectives and Methods: We review the major indications to perform both techniques, sequentially or complementarily, describe the common things that these two techniques essentially share, and discuss the ERCP-EUS single session. Also, the issues of learning curves and education of upcoming biliopancreatic endoscopists are highlighted. Conclusion: In recent years the complementation between ECRP and EUS has been growing both from a diagnostic and a therapeutic point of view, allowing optimization of the use of these techniques and the creation of a more systematized approach of patients with biliopancreatic pathology. Endoscopists with experience in both techniques will be increasingly important, suggesting a parallel formation in the training plans of future endoscopists with interest in the area.

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Endoscopic clearance of non‐complex biliary stones using fluoroscopy‐free direct solitary cholangioscopy: Initial multicenter experience

et al. 2023

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Background and AimsFluoroscopy‐free endoscopic retrograde cholangiopancreatography for common bile duct stone (CBDS) clearance is usually offered only to pregnant patients. We initiated a multicenter, randomized controlled trial comparing clearance of non‐complex CBDSs using fluoroscopy‐free direct solitary cholangioscopy (DSC) to standard endoscopic retrograde cholangiography (ERC) to evaluate the wider applicability of the DSC‐based approach. Here we report the initial results of stone clearance and safety in roll‐in cases for the randomized controlled trial.MethodsTwelve expert endoscopists at tertiary care centers in four countries prospectively enrolled 47 patients with non‐complex CBDSs for DSC‐assisted CBDS removal in an index procedure including fluoroscopy‐free cannulation. Successful CBDS clearance was first determined by DSC and subsequently validated by final occlusion cholangiogram as the ERC gold standard.ResultsFully fluoroscopy‐free cannulation was successful in 42/47 (89.4%) patients. Brief fluoroscopy with minimal contrast injection was used in 4/47 (8.5%) patients during cannulation. Cannulation failed in 1/47 (2.1%) patients. Fluoroscopy‐free complete stone clearance was reached in 38/46 (82.6%) cases. Residual stones were detected in the validation ERC occlusion cholangiogram in three cases. Overall serious adverse event rate was 2.1% (95% confidence interval 0.1–11.3): postprocedural pancreatitis in one patient.ConclusionsIn patients with non‐complex CBDS, the fluoroscopy‐free technique is easily transferred to endoscopic retrograde cholangiopancreatography experts with acceptable rates of cannulation and stone clearance and few serious adverse events. (ClinicalTrials.gov number, NCT03421340)

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Successful single‐session endosonography‐based endoscopic retrograde cholangiopancreatography without fluoroscopy in pregnant patients with suspected choledocholithiasis: a case series

Cited by 25 publications

References 15 publications

Non‐radiation endoscopic retrograde cholangiopancreatography in the management of choledocholithiasis during pregnancy

Non‐radiation endoscopic retrograde cholangiopancreatography in the management of choledocholithiasis during pregnancy

Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound: To Be One Traveler in Converging Roads

Endoscopic clearance of non‐complex biliary stones using fluoroscopy‐free direct solitary cholangioscopy: Initial multicenter experience

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