MATERNAL-FETAL MEDICINE ERCP without radiation during pregnancy in the minimal invasive world Orhan Agcaoglu • Beyza Ozcinar • Ali Fuat Kaan Gok • Fatih Yanar • Hakan Yanar • Cemalettin Ertekin • Kayihan Gunay Received: 8 December 2012 / Accepted: 7 May 2013 Ó Springer-Verlag Berlin Heidelberg 2013 Abstract Background The current guidelines recommend endo- scopic retrograde cholangiopancreatography (ERCP) pro- cedures in pregnant women with minimal radiation exposure. Regarding the safety of ERCP during pregnancy, data are limited in the literature. In this study, we report our experience with five ERCP procedures performed in five pregnant women without radiation at a single tertiary health center. Methods Between May 2007 and February 2012, five pregnant patients underwent ERCP without radiation, analyzed retrospectively. Clinical disease was confirmed with either pre-procedure ultrasonography and magnetic resonance cholangiopancreatography in all patients. In all cases, selective deep cannulation was performed and con- firmed by the aspiration and/or direct visualization of the bile. The data regarding laboratory, ultrasonography, magnetic resonance imaging, endoscopic findings, and clinical course of the patients were analyzed. Fetal com- plications were noted at delivery and 30 days postdelivery follow-up. Results The mean patient age was 26 years (22–33) and the mean duration of pregnancy was 20 weeks (12–32). In all cases, no secondary ERCP procedures were needed. Also, no maternal and fetal adverse events and complica- tions were determined after the procedures or on follow-up. All stages of the procedure including cannulation, sphincterotomy, and stone extraction were performed without the use of fluoroscopy. Conclusion As far we know, there is no report in the literature regarding the failure of endoscopic retraction of stones without fluoroscopy during pregnancy. Our series notes that ERCP is safe and prevents recurrent biliary pancreatitis during pregnancy. Unfortunately, due to the small limited number of patient data, our study notes the requirement of further large randomized and controlled series. Keywords Cholecycstectomy Á ERCP Á Fluoroscopy Á Management Á Pregnancy Á Pancreatitis Á Radiation Á Sphincterotomy Introduction Acute pancreatitis in pregnancy is a rare condition esti- mated to occur in 1 per 5,000 pregnancies [1]. During pregnancy, the volume of the gallbladder increases and the flow of bile decreases [2] and this leads to biliary disorders. Acute pancreatitis has been shown to be closely related to gallstone disease [3] and the prevelance of gallstones in pregnancy has been reported as 3.3–12.2 % [4, 5]. The other common causes of acute pacreatitis in pregnancy are gallstones (66 %), idiopathic (17 %), alcohol abuse (12 %), hyperlipidemia (4 %), and less commonly medi- cations, trauma, and fatty liver of pregnancy [6]. In the literature, biliary pancreatitis has been found to be asso- ciated with 60 % of fetal mortality [7]. Due to increased rate of surgical complications, the treatment of choice is usually conservative and the first line treatment in cho- ledocholithiasis is endoscopic retrograde cholangiopan- creatography (ERCP), which should only be used as a O. Agcaoglu Á B. Ozcinar (&) Á A. F. K. Gok Á F. Yanar Á H. Yanar Á C. Ertekin Á K. Gunay Department of General Surgery, Istanbul School of Medicine, Istanbul Medical Faculty, Istanbul University, Capa, 34093 Istanbul, Turkey e-mail: drbeyza@hotmail.com 123 Arch Gynecol Obstet DOI 10.1007/s00404-013-2890-0