Digestive Diseases and Sciences

, Volume 60, Issue 9, pp 2604–2607 | Cite as

Radiation-Free ERCP in Pregnancy: A “Sound” Approach to Leaving No Stone Unturned

  • Saurabh Sethi
  • Nirav Thosani
  • Subhas Banerjee
Stanford Multidisciplinary Seminars

Case Presentations and Evolution

Case 1

A 29-year-old 14-week pregnant woman was initially evaluated at an outside hospital with complaints of right upper quadrant pain, fever, and chills. There was no significant past medical history. Her vital signs were stable, and the clinical examination was significant only for right upper quadrant tenderness. Laboratory evaluation revealed a white cell count (WBC) 11.8 × 10 3/µL, total bilirubin (TB) 3 mg/dL, alanine transaminase (ALT) 86 U/L, aspartate transaminase (AST) 101 U/L, and alkaline phosphatase (AP) 104 U/L. A right upper quadrant ultrasound revealed gallstones, gallbladder wall thickening, peri-cholecystic fluid, and a dilated common bile duct (10 mm) without any evidence of bile duct stones. She underwent laparoscopic cholecystectomy for acute cholecystitis, with an intraoperative cholangiogram, bile duct exploration, and extraction of a bile duct stone. She was re-admitted 2 days later with abdominal pain and an increasing total...


Bile Duct Cystic Duct Choledochal Cyst Bile Duct Stone Choledocholithiasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest



  1. 1.
    Valdivieso V, Covarrubias C, Siegel F, Cruz F. Pregnancy and cholelithiasis: pathogenesis and natural course of gallstones diagnosed in early puerperium. Hepatology. 1993;17:1.PubMedGoogle Scholar
  2. 2.
    Glenn F, McSherry CK. Gallstones and pregnancy among 300 young women treated by cholecystectomy. Surg Gynecol Obstet. 1968;127:1067.PubMedGoogle Scholar
  3. 3.
    Printen KJ, Ott RA. Cholecystectomy during pregnancy. Am Surg. 1978;44:432.PubMedGoogle Scholar
  4. 4.
    Petrov MS, Savides TJ. Systematic review of endoscopic ultrasonography versus endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis. Br J Surg. 2009;96:967–974.CrossRefPubMedGoogle Scholar
  5. 5.
    Kahaleh M, Hartwell GD, Arseneau KO, et al. Safety and efficacy of ERCP in pregnancy. Gastrointest Endosc. 2004;60:287–292.CrossRefPubMedGoogle Scholar
  6. 6.
    Tham TC, Vandervoort J, Wong RC, et al. Safety of ERCP during pregnancy. Am J Gastroenterol. 2003;98:308–311.CrossRefPubMedGoogle Scholar
  7. 7.
    Axelrad AM, Fleischer DE, Strack LL, Benajmin SB, al-Kawas FH. Performance of ERCP for symptomatic choledocholithiasis during pregnancy: techniques to increase safety and improve patient management. Am J Gastroenterol.. 1994;89:109–112.PubMedGoogle Scholar
  8. 8.
    Zágoni T, Tulassay Z. Endoscopic sphincterotomy without fluoroscopic control in pregnancy. Am J Gastroenterol. 1995;90:1028.PubMedGoogle Scholar
  9. 9.
    Samara ET, Stratakis J. Elene Melono JM, Mouzas IA, Perisinakis K, Damilakis J. Therapeutic ERCP and pregnancy: is the radiation risk for the fetus trivial? Gastrointest Endosc. 2009;69:824–831.CrossRefPubMedGoogle Scholar
  10. 10.
    Binmoeller KF, Katon RM. Needle knife papillotomy for an impacted common bile duct stone during pregnancy. Gastrointest Endosc. 1990;36:607–609.CrossRefPubMedGoogle Scholar
  11. 11.
    Vohra S, Holt EW, Bhat YM, Kane S, Shah JN, Binmoeller KF. Successful single-session endosonography-based endoscopic retrograde cholangiopancreatography without fluoroscopy in pregnant patients with suspected choledocholithiasis: a case series. J Hepatobiliary Pancreat Sci. 2014;21:93–97.CrossRefPubMedGoogle Scholar
  12. 12.
    Shelton J, Linder JD, Rivera-Alsina ME, Tarnasky PR. Commitment, confirmation, and clearance: new techniques for nonradiation ERCP during pregnancy (with videos). Gastrointest Endosc. 2008;67:364–368.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Saurabh Sethi
    • 1
    • 2
  • Nirav Thosani
    • 1
    • 2
  • Subhas Banerjee
    • 1
    • 2
  1. 1.Division of Gastroenterology and HepatologyStanford UniversityStanfordUSA
  2. 2.Palo AltoUSA

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