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ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 12
Dec.  2023
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Article Navigation >  Journal of Clinical Hepatology  > 2023  >  39(12): 2885-2893

Efficacy and safety of endoscopic retrograde cholangiopancreatography during pregnancy and puerperium： A comparative analysis

DOI: 10.3969/j.issn.1001-5256.2023.12.020

  • Department of Gastroenterology，The First Affiliated Hospital of Nanchang University，Jiangxi Clinical Research Center for Gastroenterology，Nanchang 330006，China

Research funding:

National Natural Science Foundation of China (82160694);

The Project of the Jiangxi Department of Science and Technology (20202BBGL73109);

Project of the Health and Family Planning Commission of Jiangxi Province (20195082)

More Information
  • Corresponding author: ZHU Liang， 89493075@qq.com （ORCID： 0000-0001-9080-1378）
  • Received Date: 2023-03-12
  • Accepted Date: 2023-05-01
  • Published Date: 2023-12-12
    Abstract
  •   Objective  To investigate the efficacy and safety of endoscopic retrograde cholangiopancreatography （ERCP） during pregnancy and puerperium through a comparative analysis.  Methods  A retrospective analysis was performed for the clinical data of 22 patients in pregnancy and 39 patients in puerperium who received ERCP in Digestive Endoscopy Center of The First Affiliated Hospital of Nanchang University from January 2007 to August 2022. The two groups of patients were compared in terms of baseline data， diagnosis during ERCP， interventions， laboratory results before and after ERCP， post-ERCP complications， and delivery and fetal outcomes. The independent-samples t test was used for comparison of continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.  Results  There were no significant differences between the patients in pregnancy and those in puerperium in all baseline data （all P>0.05） except the rate of CT examination （22.73% vs 58.97%， χ2=7.44， P=0.006）. During the ERCP procedure， compared with the patients in puerperium， the patients in pregnancy had a significantly lower proportion of the patients who underwent biliary stone extraction or endoscopic papillary balloon dilation （χ2=4.007 and 4.315， both P<0.05） and a significantly higher proportion of the patients who did not receive X-ray fluoroscopy （χ2=12.103， P=0.001）. After ERCP， both groups had significant improvements in white blood cell count， total bilirubin， direct bilirubin， alanine aminotransferase， and aspartate aminotransferase （all P<0.05）. The overall incidence rate of post-ERCP complications was 7.04% （5/71） for all patients， with post-ERCP biliary infection as the most common complication （3/71，4.23%）， and there was no significant difference in the incidence rate of post-ERCP complications between the two groups （P>0.05）. As for delivery and fetal outcomes， compared with the patients in puerperium， the patients in pregnancy had a significantly higher proportion of patients with early termination of pregnancy （50.00% vs 0，χ2=20.528， P<0.001） and a significantly lower proportion of patients with cesarean section （36.36% vs 76.92%， χ2=4.756， P=0.029）. There were no significant differences in the incidence rates of adverse events such as abnormal fetal development and stillbirth between the two groups （P>0.05）.  Conclusion  With strict control of ERCP indications and timing， ERCP is effective and relatively safe in both pregnancy and puerperium and has a comparable incidence rate of post-ERCP complications to that in the general population， with relatively good delivery and fetal outcomes.

     

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    • References(28)
  • [1]
    de BARI O, WANG TY, LIU M, et al. Cholesterol cholelithiasis in pregnant women: Pathogenesis, prevention and treatment[J]. Ann Hepatol, 2014, 13( 6): 728- 745.
    [2]
    DENG J, HAN ZY, LU MN, et al. Analysis of prevalence, epidemic trend and characteristics of cholelithiasis[J]. Mod Dig Interv, 2022, 27( 1): 80- 83. DOI: 10.3969/j.issn.1672-2159.2022.01.018.

    邓江, 韩致毅, 卢梦楠, 等. 胆石症患病率、流行趋势及特征分析[J]. 现代消化及介入诊疗, 2022, 27( 1): 80- 83. DOI: 10.3969/j.issn.1672-2159.2022.01.018.
    [3]
    KO CW. Risk factors for gallstone-related hospitalization during pregnancy and the postpartum[J]. Am J Gastroenterol, 2006, 101( 10): 2263- 2268. DOI: 10.1111/j.1572-0241.2006.00730.x.
    [4]
    BIAN DP, DONG JP, NIU HX, et al. Value of nasobiliary cholangiography in the diagnosis of residual common bile duct stones after endoscopic retrograde cholangiopancreatography and related factors of residual common bile duct stones[J]. J Clin Hepatol, 2021, 37( 4): 868- 871. DOI: 10.3969/j.issn.1001-5256.2021.04.028.

    边大鹏, 董锦沛, 牛海霞, 等. 鼻胆管造影对经内镜逆行胰胆管造影取石术后结石残留的诊断价值及结石残留相关因素分析[J]. 临床肝胆病杂志, 2021, 37( 4): 868- 871. DOI: 10.3969/j.issn.1001-5256.2021.04.028.
    [5]
    ERCP Group, Chinese Society of Digestive Endoscopology; Group Biliopancreatic, Chinese Association of Gastroenterologist; Hepatologist National Clinical Research Center for Digestive Diseases. China ERCP guide(2018 edition)[J]. Chin J Dig Endosc, 2018, 35( 11): 777- 813. DOI: 10.3760/cma.j.issn.1007-5232.2018.11.001.

    中华医学会消化内镜学分会ERCP学组, 中国医师协会消化医师分会胆胰学组, 国家消化系统疾病临床医学研究中心. 中国ERCP指南(2018版)[J]. 中华消化内镜杂志, 2018, 35( 11): 777- 813. DOI: 10.3760/cma.j.issn.1007-5232.2018.11.001.
    [6]
    CAPPELL MS, STAVROPOULOS SN, FRIEDEL D. Systematic review of safety and efficacy of therapeutic endoscopic-retrograde-cholangiopancreatography during pregnancy including studies of radiation-free therapeutic endoscopic-retrograde-cholangiopancreatography[J]. World J Gastrointest Endosc, 2018, 10( 10): 308- 321. DOI: 10.4253/wjge.v10.i10.308.
    [7]
    SHABANZADEH DM. Incidence of gallstone disease and complications[J]. Curr Opin Gastroenterol, 2018, 34( 2): 81- 89. DOI: 10.1097/MOG.0000000000000418.
    [8]
    SHERGILL AK, BEN-MENACHEM T, CHANDRASEKHARA V, et al. Guidelines for endoscopy in pregnant and lactating women[J]. Gastrointest Endosc, 2012, 76( 1): 18- 24. DOI: 10.1016/j.gie.2012.02.029.
    [9]
    ARCE-LIÉVANO E, DEL RÍO-SUÁREZ I, VALENZUELA-SALAZAR C, et al. Endoscopic retrograde cholangiopancreatography results for the treatment of symptomatic choledocholithiasis in pregnant patients: A recent experience at a secondary care hospital in Mexico City[J]. Rev Gastroenterol Mex(Engl Ed), 2021, 86( 1): 21- 27. DOI: 10.1016/j.rgmx.2019.12.001.
    [10]
    KONDUK BT, BAYRAKTAR O. Efficacy and safety of endoscopic retrograde cholangiopancreatography in pregnancy: A high-volume study with long-term follow-up[J]. Turk J Gastroenterol, 2019, 30( 9): 811- 816. DOI: 10.5152/tjg.2019.18799.
    [11]
    TALUKDAR R. Complications of ERCP[J]. Best Pract Res Clin Gastroenterol, 2016, 30( 5): 793- 805. DOI: 10.1016/j.bpg.2016.10.007.
    [12]
    MENDEZ-SANCHEZ N, CHAVEZ-TAPIA NC, URIBE M. Pregnancy and gallbladder disease[J]. Ann Hepatol, 2006, 5( 3): 227- 230.
    [13]
    MAGNO-PEREIRA V, MOUTINHO-RIBEIRO P, MACEDO G. Demystifying endoscopic retrograde cholangiopancreatography(ERCP) during pregnancy[J]. Eur J Obstet Gynecol Reprod Biol, 2017, 219: 35- 39. DOI: 10.1016/j.ejogrb.2017.10.008.
    [14]
    SMITH I, GAIDHANE M, GOODE A, et al. Safety of endoscopic retrograde cholangiopancreatography in pregnancy: Fluoroscopy time and fetal exposure, does it matter?[J]. World J Gastrointest Endosc, 2013, 5( 4): 148- 153. DOI: 10.4253/wjge.v5.i4.148.
    [15]
    LEE JJ, LEE SK, KIM SH, et al. Efficacy and safety of pancreatobiliary endoscopic procedures during pregnancy[J]. Gut Liver, 2015, 9( 5): 672- 678. DOI: 10.5009/gnl14217.
    [16]
    OTHMAN MO, STONE E, HASHIMI M, et al. Conservative management of cholelithiasis and its complications in pregnancy is associated with recurrent symptoms and more emergency department visits[J]. Gastrointest Endosc, 2012, 76( 3): 564- 569. DOI: 10.1016/j.gie.2012.04.475.
    [17]
    NEUHAUS H. Choledocholithiasis in pregnancy: When and how to perform ERCP?[J]. Endosc Int Open, 2020, 8( 10): E1508- E1510. DOI: 10.1055/a-1196-1683.
    [18]
    FENG Q, CHENG XY, LIU Z. Safety of endoscopic retrograde cholangiopancreatography during pregnancy for disease diagnosis and treatment[J]. World Chin J Dig, 2018, 26( 4): 250- 255. DOI: 10.11569/wcjd.v26.i4.250.

    冯琴, 程晓英, 刘展. 妊娠期间行ERCP诊治的进展[J]. 世界华人消化杂志, 2018, 26( 4): 250- 255. DOI: 10.11569/wcjd.v26.i4.250.
    [19]
    AZAB M, BHARADWAJ S, JAYARAJ M, et al. Safety of endoscopic retrograde cholangiopancreatography(ERCP) in pregnancy: A systematic review and meta-analysis[J]. Saudi J Gastroenterol, 2019, 25( 6): 341- 354. DOI: 10.4103/sjg.SJG_92_19.
    [20]
    SHARMA SS, MAHARSHI S. Two stage endoscopic approach for management of choledocholithiasis during pregnancy[J]. J Gastrointestin Liver Dis, 2008, 17( 2): 183- 185.
    [21]
    RAIJMAN I. Performing endoscopic retrograde cholangiography without radiation exposure: Are we ready for it?[J]. Gastrointest Endosc, 2016, 84( 5): 770- 772. DOI: 10.1016/j.gie.2016.04.042.
    [22]
    KAMANI L, ACHAKZAI MS, ISMAIL FW, et al. Safety of endoscopy and its outcome in pregnancy[J]. Cureus, 2019, 11( 12): e6301. DOI: 10.7759/cureus.6301.
    [23]
    HAYASHI S, TAKENAKA M, HOSONO M, et al. Radiation exposure during image-guided endoscopic procedures: The next quality indicator for endoscopic retrograde cholangiopancreatography[J]. World J Clin Cases, 2018, 6( 16): 1087- 1093. DOI: 10.12998/wjcc.v6.i16.1087.
    [24]
    LAUDANNO O, GARRIDO J, AHUMARÁN G, et al. Long-term follow-up after fetal radiation exposure during endoscopic retrograde cholangiopancreatography[J]. Endosc Int Open, 2020, 8( 12): E1909- E1914. DOI: 10.1055/a-1293-7783.
    [25]
    LI LF, WEI HP, LIU GR, et al. Changes and clinical significance of aspartate aminotransferase, alanine aminotransferase and γ-glutamyl transferase in patients with cirrhosis[J]. China Mod Med, 2022, 29( 6): 110- 113. DOI: 10.3969/j.issn.1674-4721.2022.06.031.

    黎灵锋, 韦慧萍, 刘桂荣, 等. 门冬氨酸转氨酶、丙氨酸转氨酶与γ谷氨酰基转移酶在肝硬化患者中的变化及临床意义[J]. 中国当代医药, 2022, 29( 6): 110- 113. DOI: 10.3969/j.issn.1674-4721.2022.06.031.
    [26]
    AKSHINTALA VS, KANTHASAMY K, BHULLAR FA, et al. Incidence, severity, and mortality of post-ERCP pancreatitis: An updated systematic review and meta-analysis of 145 randomized controlled trials[J]. Gastrointest Endosc, 2023, 98( 1): 1- 6.e12. DOI: 10.1016/j.gie.2023.03.023.
    [27]
    LIN Y, LIN XY, CHEN R, et al. Application of ERCP in treatment of common bile duct stones after cholecystectomy[J/OL]. Chin J Hepat Surg(Electronic Edition), 2021, 10( 5): 502- 505. DOI: 10.3877/cma.j.issn.2095-3232.2021.05.015.

    林颖, 林显艺, 陈荣, 等. ERCP在胆囊切除术后胆总管结石治疗中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2021, 10( 5): 502- 505. DOI: 10.3877/cma.j.issn.2095-3232.2021.05.015.
    [28]
    INAMDAR S, BERZIN TM, SEJPAL DV, et al. Pregnancy is a risk factor for pancreatitis after endoscopic retrograde cholangiopancreatography in a national cohort study[J]. Clin Gastroenterol Hepatol, 2016, 14( 1): 107- 114. DOI: 10.1016/j.cgh.2015.04.175.
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