Multicenter experience with digital single-operator cholangioscopy in pregnant patients

Area of Science:

• Gastroenterology
• Hepatology
• Interventional Endoscopy

Background:

• Minimizing radiation exposure during pregnancy is crucial due to unknown safe dose limits.
• Standard endoscopic retrograde cholangiopancreatography (ERCP) often involves fluoroscopy, posing potential risks to pregnant patients.
• The utility of digital single-operator cholangioscopy (D-SOC) as a fluoroscopy-free alternative in pregnancy requires further investigation.

Purpose of the Study:

• To assess the technical success of D-SOC for ERCP in pregnant patients without fluoroscopy.
• To evaluate the safety profile of D-SOC during pregnancy.
• To analyze maternal and neonatal outcomes following D-SOC procedures in pregnant individuals.

Main Methods:

• An international, multicenter, retrospective study involving 6 tertiary centers.
• Inclusion criteria: pregnant patients undergoing D-SOC for bile duct stones and/or strictures.
• Data collected on technical success, radiation exposure, and maternal/neonatal outcomes.

Main Results:

• D-SOC enabled successful bile duct cannulation in all 10 patients (100%).
• Fifty percent (5/10) of patients completed a fluoroless ERCP using D-SOC.
• Mean fluoroscopy dose was 3.4 ± 7.2 mGy, with a mean fluoroscopy time of 0.5 ± 0.8 minutes. Mild bleeding and moderate pancreatitis were the only adverse events.
• Mean gestational age at delivery was 36.2 ± 2.6 weeks, with no noted birth defects.

Conclusions:

• D-SOC is a feasible and effective alternative to standard ERCP in pregnant patients.
• This technique significantly reduces or eliminates radiation exposure during ERCP in this population.
• D-SOC demonstrates a favorable safety profile for both mother and neonate.