Fluoroscopy-Free Endoscopic Retrograde Cholangiopancreatography During Pregnancy.

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an established therapeutic intervention for pancreatobiliary disorders; however, its use during pregnancy raises concerns regarding fetal exposure to ionizing radiation. Fluoroscopy-free ERCP offers an alternative approach that may avoid radiation exposure while providing effective biliary therapy. Evidence regarding its technical success and maternal and fetal safety remains limited. Objectives: To assess the technical and clinical success of fluoroscopy-free ERCP in pregnant women requiring therapeutic ERCP and to evaluate procedure-related maternal complications and pregnancy/fetal outcomes. Methods: This hospital-based observational study included 30 pregnant women undergoing fluoroscopy-free therapeutic ERCP at tertiary-care centres in Raichur. Eligible participants were recruited consecutively. Demographic, obstetric, clinical, laboratory, imaging, procedural, and pregnancy outcome data were recorded. Biliary cannulation and therapeutic interventions were performed without fluoroscopy, with biliary access confirmed using non-radiological methods. Data were analyzed using IBM SPSS Statistics version 22.0, with a p value <0.05 considered statistically significant. Results: The mean maternal age was 26.4 ± 4.8 years and mean gestational age at ERCP was 23.6 ± 7.1 weeks. Fluoroscopy-free biliary cannulation was successful in all patients, with no conversion to fluoroscopy. Overall technical and clinical success were each achieved in 96.7% of patients, while complete duct clearance at index ERCP was achieved in 86.7%. Significant post-procedural reductions were observed in total and direct bilirubin, AST, ALT ( p<0.001), and alkaline phosphatase (p=0.012). ERCP-related complications occurred in 6.7%, comprising one case each of post-ERCP pancreatitis and post-sphincterotomy bleeding. No maternal mortality, immediate fetal distress, or procedure-related pregnancy loss occurred. All pregnancies resulted in live births; 10.0% were preterm deliveries. Conclusion: Fluoroscopy-free ERCP appears to be a technically feasible and clinically effective therapeutic option during pregnancy, with favorable maternal and fetal outcomes when performed by experienced endoscopists with multidisciplinary support. Larger prospective multicentre studies are warranted to confirm its safety and effectiveness.

Keywords: Pregnancy; ERCP; fluoroscopy-free ERCP; choledocholithiasis; biliary obstruction; maternal outcomes; fetal outcomes.