Endoscopic management of biliary disease during pregnancy.

BACKGROUND: The transient but substantial alterations in the biliary system during pregnancy increase the risk of cholecystitis, choledocholithiasis, and pancreatitis. Traditionally, these disorders are managed conservatively or with operative cholecystectomy. Recent advances in fiber-optic technology allow endoscopy to be used as a safe, effective, and definitive treatment alternative for pancreaticobiliary disease in pregnancy. CASES: Three gravid women with cholelithiasis, acute cholecystitis, and/or gallstone pancreatitis were treated endoscopically with stone extraction and experienced rapid resolution of symptoms and successful pregnancy outcomes.
CONCLUSION: Aggressive endoscopic intervention for biliary disorders in pregnancy appears to decrease morbidity, mortality, and costs. Endoscopy offers a safer, more effective treatment alternative to prolonged medical management and traditional surgical intervention during pregnancy. Because biliary abnormalities resolve rapidly in the postpartum period, it is unlikely these women will need subsequent treatment.