Safety of endoscopic retrograde cholangiopancreatography (ERCP) in pregnancy: A systematic review and meta-analysis.
Endoscopic retrograde cholangiopancreatography
gallstones
pregnancy
Journal
Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association
ISSN: 1998-4049
Titre abrégé: Saudi J Gastroenterol
Pays: India
ID NLM: 9516979
Informations de publication
Date de publication:
Historique:
pubmed:
21
11
2019
medline:
16
7
2020
entrez:
21
11
2019
Statut:
ppublish
Résumé
Endoscopic retrograde cholangiopancreatography (ERCP) is a technically challenging procedure rarely associated with severe postprocedure complications. Hormonal changes during pregnancy promote cholelithiasis, but there are limited clinical data available on the outcomes of ERCP in pregnant women. ERCP techniques without irradiation were recently introduced as potential alternative. We performed a systematic review and meta-analysis to assess the safety of ERCP in pregnancy and to compare outcomes of radiation versus nonradiation ERCP. A systematic search of PubMed, Medline/Ovid, Web of Science, and Google Scholar through April 18 In all, 27 studies reporting on 1,307 pregnant patients who underwent ERCP were identified. Median age was 27.1 years. All results were statistically significant (P < 0.01). The pooled event rate for overall adverse outcomes was 15.9% (95% CI = 0.132-0.191) in all studies combined, 17.6% (95% CI = 0.109-0.272) in nonradiation ERCP (NR-ERCP) subgroup and 21.6% (95% CI = 0.154-0.294) in radiation ERCP subgroup. There was no significant difference in the pooled event rate for fetal adverse outcomes in NR-ERCP 6.2% (95% CI = 0.027-0.137) versus 5.2% (95% CI = 0.026-0.101) in radiation ERCP group. There was no significant difference in maternal pregnancy-related adverse outcome event rate between NR-ERCP (8.4%) (95% CI = 0.038-0.173) and radiation ERCP (7.1%) (95% CI = 0.039-0.125). Maternal nonpregnancy-related adverse outcome event rate in NR-ERCP was 7.6% (95% CI = 0.038-0.145), which was half the event rate in radiation ERCP group of 14.9% (95% CI = 0.102-0.211). ERCP done by experienced endoscopists is a safe procedure during pregnancy. Radiation-free techniques appear to reduce the rates of nonpregnancy-related complications, but not of fetal and pregnancy-related complications.
Sections du résumé
BACKGROUND/AIMS
OBJECTIVE
Endoscopic retrograde cholangiopancreatography (ERCP) is a technically challenging procedure rarely associated with severe postprocedure complications. Hormonal changes during pregnancy promote cholelithiasis, but there are limited clinical data available on the outcomes of ERCP in pregnant women. ERCP techniques without irradiation were recently introduced as potential alternative. We performed a systematic review and meta-analysis to assess the safety of ERCP in pregnancy and to compare outcomes of radiation versus nonradiation ERCP.
MATERIALS AND METHODS
METHODS
A systematic search of PubMed, Medline/Ovid, Web of Science, and Google Scholar through April 18
RESULTS
RESULTS
In all, 27 studies reporting on 1,307 pregnant patients who underwent ERCP were identified. Median age was 27.1 years. All results were statistically significant (P < 0.01). The pooled event rate for overall adverse outcomes was 15.9% (95% CI = 0.132-0.191) in all studies combined, 17.6% (95% CI = 0.109-0.272) in nonradiation ERCP (NR-ERCP) subgroup and 21.6% (95% CI = 0.154-0.294) in radiation ERCP subgroup. There was no significant difference in the pooled event rate for fetal adverse outcomes in NR-ERCP 6.2% (95% CI = 0.027-0.137) versus 5.2% (95% CI = 0.026-0.101) in radiation ERCP group. There was no significant difference in maternal pregnancy-related adverse outcome event rate between NR-ERCP (8.4%) (95% CI = 0.038-0.173) and radiation ERCP (7.1%) (95% CI = 0.039-0.125). Maternal nonpregnancy-related adverse outcome event rate in NR-ERCP was 7.6% (95% CI = 0.038-0.145), which was half the event rate in radiation ERCP group of 14.9% (95% CI = 0.102-0.211).
CONCLUSIONS
CONCLUSIONS
ERCP done by experienced endoscopists is a safe procedure during pregnancy. Radiation-free techniques appear to reduce the rates of nonpregnancy-related complications, but not of fetal and pregnancy-related complications.
Identifiants
pubmed: 31744939
pii: 271339
doi: 10.4103/sjg.SJG_92_19
pmc: PMC6941455
doi:
Types de publication
Comparative Study
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
341-354Commentaires et corrections
Type : CommentIn
Déclaration de conflit d'intérêts
None
Références
ANZ J Surg. 2009 Jan-Feb;79(1-2):23-6
pubmed: 19183374
Gastroenterol Hepatol (N Y). 2009 Dec;5(12):851-5
pubmed: 20567530
J Gastrointestin Liver Dis. 2008 Jun;17(2):183-5
pubmed: 18568140
Hepatology. 1993 Jan;17(1):1-4
pubmed: 8423030
Nat Rev Gastroenterol Hepatol. 2011 Oct 04;8(11):610-34
pubmed: 21970872
Gastrointest Endosc. 2009 Mar;69(3 Pt 1):453-61
pubmed: 19136111
Chin Med J (Engl). 2013 Jan;126(1):46-50
pubmed: 23286476
Am J Gastroenterol. 1995 Aug;90(8):1263-7
pubmed: 7639227
Gastrointest Endosc. 2012 Jul;76(1):18-24
pubmed: 22579258
Gastrointest Endosc. 2008 Apr;67(4):669-72
pubmed: 18374026
Eur J Obstet Gynecol Reprod Biol. 2017 Dec;219:35-39
pubmed: 29040894
Control Clin Trials. 1986 Sep;7(3):177-88
pubmed: 3802833
World J Gastrointest Endosc. 2014 Aug 16;6(8):352-8
pubmed: 25132918
Health Technol Assess. 2003;7(27):iii-x, 1-173
pubmed: 14499048
Ann Intern Med. 2009 Aug 18;151(4):264-9, W64
pubmed: 19622511
Arch Gynecol Obstet. 2013 Dec;288(6):1275-8
pubmed: 23715923
Surg Endosc. 1998 May;12(5):394-9
pubmed: 9569356
J Laparoendosc Adv Surg Tech A. 2013 May;23(5):437-40
pubmed: 23452176
Curr Gastroenterol Rep. 2012 Dec;14(6):504-10
pubmed: 23011675
Rev Esp Enferm Dig. 2012 Feb;104(2):53-8
pubmed: 22372797
Int J Gynaecol Obstet. 2007 Nov;99(2):147-9
pubmed: 17900582
Gastrointest Endosc Clin N Am. 2006 Jan;16(1):1-31
pubmed: 16546020
Hepatobiliary Pancreat Dis Int. 2011 Feb;10(1):107
pubmed: 21269945
Am J Obstet Gynecol. 2004 May;190(5):1467-9
pubmed: 15167871
Surg Endosc. 2000 Mar;14(3):267-71
pubmed: 10741447
World J Gastrointest Endosc. 2013 Apr 16;5(4):148-53
pubmed: 23596536
Radiat Prot Dosimetry. 2016 Mar;168(3):401-7
pubmed: 26084305
J Hepatobiliary Pancreat Sci. 2014 Feb;21(2):93-7
pubmed: 23798477
Hepatology. 2005 Feb;41(2):359-65
pubmed: 15660385
Am J Surg. 1994 Dec;168(6):576-9; discussion 580-1
pubmed: 7977999
Indian J Gastroenterol. 2005 Jul-Aug;24(4):161-3
pubmed: 16204904
Gastrointest Endosc. 2012 Nov;76(5):1069-70
pubmed: 22260887
Surg Endosc. 2016 Jan;30(1):222-8
pubmed: 25840897
Clin Gastroenterol Hepatol. 2016 Jan;14(1):107-14
pubmed: 25952311
World J Gastroenterol. 2009 Aug 7;15(29):3649-52
pubmed: 19653343
Turk J Obstet Gynecol. 2016 Dec;13(4):178-182
pubmed: 28913118
Gastroenterology. 2017 Feb;152(3):554-563.e9
pubmed: 27773807
Gastrointest Endosc. 2004 Aug;60(2):287-92
pubmed: 15278066
Am J Gastroenterol. 2003 Feb;98(2):308-11
pubmed: 12591046
World J Gastrointest Endosc. 2014 May 16;6(5):156-67
pubmed: 24891928
Hepatobiliary Pancreat Dis Int. 2016 Aug;15(4):434-8
pubmed: 27498585
Clin Res Hepatol Gastroenterol. 2011 Nov;35(11):772-4
pubmed: 21955516
Gastrointest Endosc. 2012 Sep;76(3):564-9
pubmed: 22732875
Gastrointest Endosc. 2008 Oct;68(4):642-6
pubmed: 18534582
Obstet Gynecol. 2016 Feb;127(2):e75-80
pubmed: 26942391
Gut Liver. 2015 Sep 23;9(5):672-8
pubmed: 26087783
Gastrointest Endosc. 2008 Feb;67(2):364-8
pubmed: 18226705
Endoscopy. 2012 Apr;44(4):408-21
pubmed: 22438152
Singapore Med J. 2006 Jun;47(6):525-8
pubmed: 16752022