Radiation-free ERCP in pregnancy

Meenatchi. S

Physician Assistant in Dept of Medical Gastroenterology & Hepatology

Kauvery Hospital, Cantonment, Trichy

Background

Physiologic changes during pregnancy are known to predispose to biliary disease. High levels of estrogen stimulate hepatic production and secretion of cholesterol. Rising progesterone also delays emptying of the gallbladder, which causes bile stasis and slows the release of bile acids that bind cholesterol. Together, these lead to the development of cholesterol gallstones.

For pregnant patients with gallstone disease complicated by cholangitis or choledocholithiasis. Endoscopic retrograde cholangio pancreatography (ERCP) guided intervention can be performed safely and successfully.

Introduction-ERCP

Endoscopic retrograde cholangio pancreatography (ERCP) is a combined endoscopic and fluoroscopic procedure in which an endoscope is led into a second part of the duodenum, making it possible for passage of other tools via the major duodenal papilla into the biliary and pancreatic ducts.

The side-viewing duodenoscope is considered the standard for ERCP procedure as it allows a better view of the major duodenal papilla, rendering cannulation easier. Contrast material may be injected in these ducts, allowing for radiologic visualization and therapeutic interventions when indicated.

Endoscopic retrograde cholangio pancreatography (ERCP) is a technically challenging procedure rarely associated with severe post procedure complications. ERCP without irradiation were recently introduced as potential alternative in pregnant women.

Case presentation

A 27 years old female/Gravida 2/3 months of amenorrhoea

Co-morbid: Nil

Chief Complaints

Right hypochondriac and epigastric pain / bilious vomiting / pale colour stools / yellowish discoloration of urine for 3 days.
No fever / pruritus / backache
Initially evaluated elsewhere – Distal CBD calculus (7mm) with IHBRD / GB sludge in USG abdomen.

On Examination

Patient conscious, oriented, afebrile PR: 106/min, BP: 100/60mmHg, SpO2: 98% in room air CVS: S1S2 (+), RS: BAE (+) P/A: Right hypochondriac and epigastric tenderness (+).

Lab parameters (Outside)