Gastrointestinal endoscopy in the pregnant woman

Table 5 Recommendations for endoscopic retrograde cholangiopancreatography during pregnancy¹

1 Weigh conservative management and/or deferral. Radiation early in gestation is a particular concern. Second trimester may be optimal time

2 Consult with obstetrician

3 Consult with radiation physicist if feasible to calculate appropriate dosimetry

4 Obtain MRCP if useful and available

5 Employ experienced ERCP physician

6 Endoscopic ultrasound may obviate ERCP (if CBD gallstones are not extremely likely)

7 Shield fetus/Employ unit with highly collimated beam/Avoid continuous radiation

8 Employ tactics to minimize/obviate radiation: Aspirate bile/intraductal ultrasound/biliary balloon sweeps w/o fluoroscopy/cholangioscopy/biliary stent placement

9 Avoid taking hard copy radiographs of findings because these use greater amounts of radiation than fluoroscopy

10 Minimize monopolar cautery during sphincterotomy. Employ grounding pad so that electric current does not traverse uterus/fetus

¹These current recommendations incorporate the American Society for Gastrointestinal Endoscopy (ASGE) guidelines[4] as recommendations 1,2,5, and 7-10, but the current report adds recommendations 3 and 4 that were not addressed in the ASGE guidelines. ERCP: Endoscopic retrograde cholangiopancreatography; MRCP: Magnetic resonance cholangiopancreatography; CBD: Common bile duct.