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[Endoscopic management of choledocholithiasis during pregnancy]
Alfredo Güitrón-Cantú1, Raúl Adalid-Martínez, José A Gutiérrez-Bermúdez
1Departamento de Endoscopia Digestiva, Hospital de Especialidades No 71, Instituto Mexicano del Seguro Social, Blvd. Revolución y Calle 26, C.P. 27000 Torreón, Coahuila.
Background:
Gallstones and extrahepatic biliary obstruction is a difficult management problem during pregnancy. Choledocholithiasis may cause cholangitis or pancreatitis, potentially life-threatening conditions. As surgery may result in significant fetal mortality when performed on these patients. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) are preferred and could be performed safely in pregnant women provided suitable precautions are taken to minimize exposure to radiation.
Objective:
To show our experience in ERCP and ES for symptomatic choledocholithiasis during pregnancy.
Material And Patients:
We described our experience in seven young women (mean age, 27.4 years) who presented with symptoms caused by choledocholithiasis, one in first trimester of pregnancy, four in second trimester, and two in third month. All had obstructive jaundice corroborated by abnormal liver function test and dilation of biliary tree on abdominal ultrasound.
Results:
All had ERCP, ES, and stone extraction without complication and went on to deliver healthy babies at term. A lead apron was positioned over the abdomen of the mother to shield the fetus during roentgenographic fluoroscopy. Mean fluoroscopy time was 26 (range, 5-60 sec).
Conclusions:
Endoscopic management should be considered in women presenting with choledocholithiasis during pregnancy.