Safety of endoscopical procedures during pregnancy

Data on safety issues and therapeutic outcomes of endoscopy in pregnancy remains limited especially in the local context. The concerns are that of safety in sedation and radiation to the foetus, effects on the pregnancy, the need for special precautions on mother and foetus during the procedure and long-term foetal outcome. We report a case series on four pregnant women to address these concerns and outline their therapeutic approaches.

We reviewed four patients who underwent oral gastroduodenoscopy (OGD) or endoscopic retrograde cholangiopancreatography (ERCP) during their pregnancies. Lead aprons were used to shield the foetuses in all patients that underwent ERCP. Sedation was given when necessary, and an anaesthetist was employed in one case for close patient monitoring. Fluoroscopy was minimised and radiographs were taken only when essential.

The mean patient age was 27.8 years (range 23-35 years). The mean gestation was 21.5 weeks (range 14-32 weeks), with two patients each being in their second and third trimesters. The indications for ERCP were cholangitis and pancreatitis (one), choledocholithiasis on ultrasonography (two), and that for OGD was persistent vomiting (one). Two patients underwent sphincterotomy and one had a biliary stent inserted. One patient was lost to follow-up. The other three had a full-term normal delivery and all babies were healthy at birth with good birth weight and normal Apgar scores.

Our series showed that endoscopic procedures in pregnancy are safe for both mother and foetus. However, these procedures should be restricted to cases with definite. indications and radiation exposure should be minimised with additional safety precautions such as minimal radiation exposure and the use of lead shield when applicable.