Gastrointestinal endoscopy in the pregnant woman

Table 4 Concerns about performance of endoscopic retrograde cholangiopancreatography during pregnancy

1 The procedure is technically challenging

2 The patient is normally placed in prone position for ERCP with consequently decreased placental perfusion for the significant duration of the procedure

3 The patient requires considerable anesthetic medications during ERCP due to discomfort during this particularly prolonged procedure

4 Patients often have preexisting pain and significant acute disease, such as gallstone pancreatitis or cholangitis

5 Fluoroscopy is usually required during ERCP with consequent fetal radiation exposure

6 Complications are more common in ERCP than in other endoscopic procedures and can potentially be severe (e.g., pancreatitis, cholangitis, hemorrhage)

7 Sphincterotomy entails monopolar electrocautery with current possibly traversing the fetus

8 Endoscopic sphincterotomy entails risks of postsphincterotomy bleeding or perforation

9 Repeat procedures may be required, such as ERCP for retained biliary stones or stent malfunction and cholecystectomy for gallstones

ERCP: Endoscopic retrograde cholangiopancreatography.