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Endoscopic retrograde cholangiopancreatography (ERCP) in pregnancy

Suku George, MD, MPH, FACP
Marc F Catalano, MD, FACG, FACP, FASGE, AGAF
Section Editors
Charles J Lockwood, MD, MHCM
Douglas A Howell, MD, FASGE, FACG
Deputy Editor
Kristen M Robson, MD, MBA, FACG


Pregnancy is associated with an increased risk of gallstone formation. Fortunately, complications due to cholelithiasis, such as cholecystitis, choledocholithiasis, and pancreatitis, are relatively uncommon, and in many cases can be managed conservatively [1-3]. (See "Gallstones in pregnancy" and "Intercurrent hepatobiliary disease during pregnancy" and "Epidemiology of and risk factors for gallstones".)

However, occasionally, patients develop complications related to gallstones that require intervention during pregnancy [1-3]. Although there are no precise estimates of the incidence, several reports have found that biliary tract disease (most commonly cholecystitis) represented one of the most frequent indications for non-obstetrical surgery during pregnancy [4-6].

A subset of patients requires endoscopic retrograde cholangiopancreatography (ERCP), most commonly for choledocholithiasis or presumed gallstone pancreatitis. Opinions regarding the safety of ERCP during pregnancy differ in various reports [7-13]. Major concerns surround issues related to radiation exposure to the fetus and the risk of the procedure on pregnancy outcome.

A general principle in the care of women with an acute biliary tract disorder during pregnancy is to provide the most conservative management possible with the hope of delaying intervention until after pregnancy or until the second trimester, when surgical intervention is relatively safest. (See "Management of the pregnant patient undergoing nonobstetric surgery".)


Few ERCP-related complications to the mother or fetus have been reported. Data on safety of ERCP in pregnancy are limited [14,15]. A literature review described complications that were reported during a total of 64 ERCPs performed during pregnancy (mostly described in case series of one to four patients) [11,16-38]. Of these procedures, 14 were done in the first trimester, 23 in the second, 19 in the third, and 8 unspecified. Therapeutic procedures included 56 sphincterotomies. Of 47 pregnancies that were followed to term, there were two premature births. Conservative treatment of a type I choledochal cyst resulted in cyst rupture at 18 weeks of gestation with subsequent peritonitis [39]. Spontaneous abortion of the fetus occurred after surgery. A patient with a pancreatic pseudocyst who underwent diagnostic ERCP before EUS-guided cyst-gastrostomy has also been reported [40]. (See "Endoscopic retrograde cholangiopancreatography: Indications, patient preparation, and complications".)

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Literature review current through: Nov 2017. | This topic last updated: Jan 09, 2017.
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