Commitment, confirmation, and clearance: new techniques for nonradiation ERCP during pregnancy (with videos)

BackgroundSymptomatic choledocholithiasis during pregnancy can be treated with ERCP, but fluoroscopy may pose a risk to the fetus. Nonradiation ERCP may be a safer form of treatment, but its performance has not been optimized.ObjectivesThe purpose of this study was to evaluate new methods of nonradiation ERCP during pregnancy, including wire-guided cannulation techniques to achieve bile-duct access without the use of fluoroscopy, and the use of peroral choledochoscopy to confirm ductal clearance.Study DesignA retrospective review of consecutive ERCPs performed on pregnant women.SettingUrban referral hospital.PatientsPregnant women with symptomatic choledocholithiasis.InterventionsAll patients underwent therapeutic ERCP without any use of fluoroscopy. Endoscopist-controlled wire-guided cannulation was performed to achieve biliary access.Main Outcome MeasurementsThe rate of successful biliary cannulation and short-term outcomes.LimitationsERCP procedures were performed by a single endoscopist.ResultsSuccessful bile-duct cannulation with sphincterotomy and the removal of biliary stones or sludge was performed without fluoroscopy in 21 pregnant women. There was one case of mild post-ERCP pancreatitis. Choledochoscopy confirmed ductal clearance in 5 cases.ConclusionsNonradiation ERCP is a safe and effective treatment for symptomatic choledocholithiasis during pregnancy. Wire-guided biliary cannulation and choledochoscopy may enhance the performance of ERCP in this setting.