Systematic review of safety and efficacy of therapeutic endoscopic-retrograde-cholangiopancreatography during pregnancy including studies of radiation-free therapeutic endoscopic-retrograde-cholangiopancreatography

Table 3 Literature review of relatively large clinical studies on safety of endoscopic retrograde cholangiopancreatography during pregnancy

First author, yr, reference	Study characteristics	Findings
Tang SJ, 2009[39]	Large retrospective study of 68 ERCPs performed during 65 pregnancies.	Pancreatitis occurred in 11 pregnant patients (16%) after ERCP. No other major maternal complications occurred during pregnancy. No fetal deaths and no fetal malformations occurred. After ERCP 53 patients had deliveries at term (90% rate for known delivery outcomes). However, ERCP performed during first trimester had less favorable outcomes: preterm delivery = 20%, and low-birth-weight infants = 21%
Ludvigsson JF, 2017[42]	National cohort study in Sweden of 58 pregnant patients undergoing ERCP included in a much larger study of 3052 patients undergoing any gastrointestinal endoscopy during pregnancy.	Of 58 pregnant patients undergoing ERCP unfavorable fetal outcomes included: 3 (5.2%) preterm births, 0 (0%) stillbirths, 0 (0%) neonatal deaths, 12 (20.7%) Cesarean sections, 1 (1.7%) Apgar score < 7 at 5 min, 1 (1.7%) small for gestational age, and 3 (5.2%) with any major congenital malformation. All these pregnancy outcomes were similar to that of pregnancy outcomes for mothers not undergoing endoscopy during pregnancy
Jamidar PA, 1995[15]	Retrospective study of therapeutic ERCPs performed during 20 pregnancies.	Two significant complications: one spontaneous abortion 3 wk after ERCP, and 1 neonatal death 26 h. post-partum that occurred after the expectant mother underwent 3 therapeutic ERCPs during pregnancy with pancreatic stenting at each session complicated by post-ERCP pancreatitis. No other significant maternal or fetal complications
Gupta R, 2005[44]	Retrospective study of therapeutic ERCPs performed during 18 pregnancies for choledocholithiasis.	Complications: 1 mild postsphincterotomy bleed; and 1 mild pancreatitis and preterm labor after ERCP. All fetal outcomes were favorable. This study had long-term follow-up after intra-partum ERCP: all 18 infants had normal child development at 6 yr
Cappell MS, 2011[45]	Systematic literature review of 296 pregnant patients undergoing therapeutic ERCP including 254 (86%) in which fetal outcome was reported.	Fetal outcomes as reported in 254 cases included: healthy infants at birth in 237, prematurely born infants with low-birth-weight in 11, late spontaneous abortions in 3, infant death soon after birth in 2, and voluntary abortion in 1. Perinatal mortality was only about 1% despite pregnant mothers undergoing therapeutic ERCP mostly for major gallstone complications, such as obstructive jaundice, ascending cholangitis, or gallstone pancreatitis. No congenital anomalies were reported in the infants. These favorable data must be interpreted cautiously: in this literature review, fetal outcome data were missing in 42 (15%) of reported mothers undergoing ERCP during pregnancy

ERCP: Endoscopic retrograde cholangiopancreatography.