P0045 - Procedural, Pregnancy, and Fetal Outcomes of Endoscopic Retrograde Cholangiopancreatography Performed During Pregnancy

Yinglin Gao, DO, John J. Kim, MD, MS
Loma Linda University Health, Loma Linda, CA

Introduction: The risk of symptomatic gallbladder disease including choledocholithiasis is increased during pregnancy and associated with substantial maternal and fetal morbidity. Clinical outcomes following ERCP in the pregnant population is not well-described. The aim of the study was to evaluate the procedural, pregnancy, and fetal outcomes in women receiving ERCP during pregnancy.

Methods: Consecutive patients (6/2013-4/2023) with confirmed pregnancy at the time of receiving ERCP at single center were searched from an endoscopic database and verified by medical records. In patients receiving multiple ERCPs, the first procedure was chosen as the index case. Pregnancy was defined by abnormal serum or urine human chorionic gonadotropin test with clinical corroboration by an obstetrician. Primary endpoints include clinical success, ERCP-related adverse events, pregnancy, and fetal outcomes.

Results: During the study period, 33 patients (mean age 26.6+5.6 years) received ERCP at the time of confirmed pregnancy including 10 (30%) in the first, 14 (42%) in the second, and 9 (27%) in the third trimester. 32 (97%) patients received ERCP for suspected choledocholithiasis, including 5 (16%) for suspected acute cholangitis and 2 (6%) with gallstone pancreatitis after receiving MRCP in 28 (85%) and EUS in 11 (33%). One (3%) patient received ERCP for symptomatic pancreatic duct stone. Procedural characteristics are shown in Table. Procedural and clinical success were achieved in all patients without documented procedure related adverse events or fetal distress during a mean hospital stay 2.2±1.9 days after ERCP. Of the 5 (15%) patients who received ERCP with a biliary stent, repeat ERCP for stent removal performed post-partum in 2 (40%), during second trimester in 1 (20%), and lost to follow-up in 2 (40%). Of the 14 patients with intact gallbladder at the time of ERCP, cholecystectomy was performed during pregnancy in 10 (71%) and 4 (29%) post-partum. During the pregnancy course, fetal loss was observed in 3 (9%) patients including one in first, one in second, and one in third trimester. Of the neonates with available delivery data (N=11), 3 infants were delivered preterm including twin gestation in 2 and large for gestational age in 1, all requiring neonatal intensive care.

Discussion: In patients with mostly choledocholithiasis during pregnancy, ERCP demonstrated high efficacy and excellent procedural safety. However higher than expected pregnancy and neonatal morbidity were observed in this population.



Disclosures:


Yinglin Gao, DO, John J. Kim, MD, MS. P0045 - Procedural, Pregnancy, and Fetal Outcomes of Endoscopic Retrograde Cholangiopancreatography Performed During Pregnancy, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.