Gastroenterology Grand Rounds

BCM Gastroenterology Grand Rounds - Take Home Lessons

The main lessons to take home concerning this case are:

1. ERCP is safe and effective for both the mother and the fetus in managing complicated gallstone disease during pregnancy, including choledocholithiasis, gallstone pancreatitis, and cholangitis.

2. Radiation exposure to the fetus should be minimized by shielding the pelvis and lower abdomen with lead, minimizing fluoroscopy time, and obtaining hard copies of radiographs only when essential.

3. Laparoscopic cholecystectomy is safe during pregnancy and is preferably performed during the second or early third trimester of pregnancy. It is debatable whether it is necessary to perform this procedure during pregnancy after endoscopic intervention with biliary sphincterotomy and stone extraction, particularly when the mother is asymptomatic for the duration of her pregnancy.