Two Stage Endoscopic Approach for Management of
Choledocholithiasis during Pregnancy
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Shyam Sunder Sharma, Sudhir Maharshi
Department of Gastroenterology, SMS Medical College, Jaipur,
India
Abstract
Background and aim. Management of choledocholithiasis
during pregnancy is difficult. The aim of this study was to evaluate
the safety and efficacy of managing common bile duct (CBD) stones
during pregnancy using a two-stage procedure without any fetal
radiation exposure.
Patients and methods. Eleven consecutive pregnant
women treated endoscopically for choledocholithiasis between 1996-2005,
at a tertiary referral center, were included in this study. All
the patients were treated by biliary sphincterotomy and stenting
without any fluoroscopy or ultrasound assistance during pregnancy
and definitive ERCP and stone clearance after delivery. Patients
were followed at one week and were asked to come for definitive
treatment after delivery.
Results. All 11 patients were experiencing pain
and jaundice while two patients had cholangitis. Abdominal ultrasound
revealed dilated CBD in all patients and stones in 8 patients.
Every patient demonstrated marked relief after the first stage
procedure without any complication. ERCP after delivery revealed
no CBD stones in one patient, 5-8 mm size stones in 8 patients
and large stones (>15mm) in two patients. One patient with
large CBD stones required mechanical lithotripsy while another
required surgery. CBD was cleared in 8 patients with small stones.
Long-term fetal and maternal outcome was good in all the patients.
Conclusion. A two stage approach consisting
of initial sphincterotomy with stenting without fluoroscopy during
pregnancy followed by definitive ERCP after delivery seems to
be a justified approach. This is the best most definitive way
of avoiding radiation exposure to the fetus.
Key words
Choledocholithiasis - pregnancy - endoscopic management
