Endoscopic Common Bile Duct Stone Clearance during Pregnancy: Challenges and Solutions A Retrospective Cohort Study

Background: Pregnancy is associated with a higher risk of common bile duct stones. Currently Endoscopic Retrograde Cholangiopancreatography (ERCP) is the treatment of choice for symptomatic choledocholithiasis. However, ERCP during pregnancy is associated with the hazard of radiation exposure, as well as challenging patient positioning and anaesthesia.Objectives: The present trial aimed to overcome the challenges associated with endoscopic clearance of symptomatic common bile duct stones during pregnancy, without adding risks or hazards either on foetus or mother.Patients and methods: This was a retrospective analysis of endoscopic CBD clearance in 27 pregnant patients with symptomatic choledocholithiasis between February 2019 and February 2023. Sedation and anaesthesia were performed safely by a senior anaesthetist, and the endoscopic procedure was performed in left lateral decubitus instead of the prone position. The gravid uterus was kept away from the monopolar electrocautery current pathway. Radiocontrast injection and fluoroscopy were deleted and replaced by transabdominal US and endoscopic bile aspiration. The data were collected, tabulated, and analysed by SPSS ver. 26.Results: Patient age ranged from 18 to 36 years (mean: 25 years). The mean duration of gestation ranged from 7-32 (mean 15 weeks), 17 patients were in the first trimester, 8 patients were in the second trimester, and two patients were in the third trimester. Therapeutic ERCP was successfully performed in all patients. The duration of the procedure ranged from 19 to 45 minutes (mean: 27± 13 minutes). As regards post-ERCP complications, one patient (3.7%) developed pancreatitis post-ERCP and was treated successfully with conservative treatment, and one patient (3.7%) with minor bleeding. All procedures were performed without any maternal adverse events immediately or during follow-up. There were no signs of foetal distress during any of these cases, and no foetal complications were noted upon delivery or at the 30-day follow-up.Conclusion: Endoscopic clearance of symptomatic common bile duct stones during pregnancy can be achieved safely without fluoroscopy. Adjunct US and endoscopic bile aspiration can overcome the absence of fluoroscopy. Careful positioning of the patient, proper positioning of the monopolar cautery pad, and judicious anaesthetic modification are all crucial for patient and foetal safety.