Original articleClinical endoscopyConservative management of cholelithiasis and its complications in pregnancy is associated with recurrent symptoms and more emergency department visits
Section snippets
Patients
After obtaining Institutional Review Board permission, we underwent a retrospective chart review of the records of patients with biliary disease in pregnancy in the period January 1998 to January 2009. We performed a search on all pregnant patients in this time period with the International Classification of Disease codes for acute cholecystitis, chronic cholecystitis, choledocholithiasis, acute pancreatitis, and recurrent biliary colic. We also searched for the Current Procedural Terminology
Data
The following data were collected in an Access database 2007 (Microsoft Corp., Redmond, WA): age of patient, trimester of pregnancy, diagnostic imaging results (US, MRCP), nature of the gallbladder disease (cholelithiasis, sludge, choledocholithiasis, cholecystitis), symptoms, associated complications including ascending cholangitis or acute biliary pancreatitis, laboratory test data, the use of fluoroscopy during the procedure, the use of sedation during the procedure, duration of the
Statistical analysis
Continuous data were reported as mean and standard deviation (SD). Categorical data were reported as proportions. The Fisher exact test was used to measure the association between categorical data. An unpaired t test was used to measure the association between continuous data. A P value of < .05 was considered statistically significant. All analyses were performed by using SAS, Version 9 (Statistical Analysis System, Cary, NC). Subgroup analysis was done for patients with recurrent biliary
Patient characteristics
A total of 112 pregnant patients were included in this study. Mean age at presentation was 25 years. A total of 66 patients (59%) were Hispanic, 29 patients (25.8%) presented in the first trimester, 43 patients (38.3%) presented in the second trimester, and 40 patients (35.7%) presented in the third trimester. Recurrent gallbladder colic was noted in 56 patients, biliary pancreatitis in 27 patients, acute cholecystitis in 17 patients, and CBD obstruction in 12 patients. The conservative
ERCP
Among the 17 patients who underwent ERCP, 4 were in the first trimester, 7 in the second trimester, and 6 in the third trimester. Eleven patients presented with CBD obstruction, 4 with biliary pancreatitis, and 2 with recurrent biliary colic. ERCP was performed at a mean of 3.7 days after the onset of the symptoms by experienced endoscopists. The mean duration of the procedure was 43 minutes. The CBD cannulation rate was 100%. Biliary sphincterotomy was done in 15 patients (88%). Precut biliary
Biliary-related outcomes
In our cohort, 81 patients continued to receive gastroenterology follow-up in our hospital (50 in the conservative treatment group and 31 in the active intervention group). Only 4 patients (12.9%) in the active intervention group (either LC or ERCP) had recurrent biliary symptoms, whereas 30 patients (60%) in the conservative treatment group had recurrent biliary symptoms in the follow-up period. The number of recurrent biliary symptoms was significantly higher in the conservative treatment
Discussion
In this study, pregnant patients with symptomatic cholelithiasis treated with conservative treatment had more episodes of recurrent biliary symptoms and a higher number of emergency department visits and hospitalizations related to biliary complications. Conservative management also resulted in early induction of labor related to biliary symptoms in 14% of patients. The mode of delivery was cesarean section in 35% of patients treated conservatively, which is significantly higher than that in
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Gastrointestinal disorders
2021, Clinical Pharmacology During PregnancyThe impact of pregnancy on the outcome of biliary acute pancreatitis
2020, Revista de Gastroenterologia de MexicoAssociation of complicated gallstone disease in pregnancy and adverse birth outcomes
2020, American Journal of SurgeryCitation Excerpt :Several retrospective studies have shown that operative management of CGD is safe during pregnancy and associated with decreased recurrence of symptoms, decreased frequency of hospitalization, and decreased number of hospital days with no significant increase in adverse birth outcomes.2,3,9,15–19 Each of these studies is limited by small sample size, with the largest examining a total of 112 patients.19 Based on the results of these studies, guidelines published by multiple professional societies including the Society of American Gastrointestinal and Endoscopic Surgeons, the American College of Gastroenterology, and the American Academy of Family Physicians recommend the safe use of laparoscopy for the treatment of CGD during pregnancy.20–22
Nonfetal Imaging During Pregnancy: Acute Abdomen/Pelvis
2020, Radiologic Clinics of North AmericaCitation Excerpt :Thin-cut MRCP images are helpful to localize stones, and steady-state images are helpful to confirm that an area of low signal intensity is a stone and not a flow void with low signal intensity. Endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy can be safely performed in pregnant women.33 By comparison, conservative management of cholelithiasis and its complications is associated with frequent emergency department visits and recurrent biliary symptoms.33
ERCP and elective cholecystectomy are safe in pregnant patients with acute biliary pancreatitis
2019, Gastrointestinal EndoscopyEndoscopic intervention and cholecystectomy in pregnant women with acute biliary pancreatitis decrease early readmissions
2019, Gastrointestinal EndoscopyCitation Excerpt :As seen in our study, a large population-based study also found that pregnant women with gallstone-associated acute pancreatitis were less likely to undergo cholecystectomy or ERCP with biliary sphincterotomy than their age-matched cohort of nonpregnant women.6 Besides, in another study, opting for conservative measures in pregnant patients was associated with more emergency department visits and additional hospitalizations than was found in their counterparts who underwent cholecystectomy or ERCP.5 Endoscopic biliary decompression is indicated in pregnant women who develop ABP complicated by cholangitis or suspicion of choledocholithiasis and may be the therapeutic modality of choice when cholecystectomy is not feasible.3,17,18
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
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