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Endoscopy in pregnancy: risks versus benefits

Nature Clinical Practice Gastroenterology & Hepatology volume 2, pages 376–377 (2005)Cite this article

Endoscopy in pregnant patients presents unique concerns regarding the safety and benefit of this procedure to the fetus. Every year in America >12,000 pregnant women have a strong indication for esophagogastroduodenoscopy (EGD), >6,000 for sigmoidoscopy or colonoscopy, and ∼1,000 for therapeutic endoscopic retrograde cholangiopancreatography (ERCP).1

The theoretical risks to the fetus from endoscopy are numerous. Particularly during organogenesis in the first trimester, the fetus is susceptible to the potentially teratogenic medications used in various endoscopic procedures. Further trauma to the fetus could be caused by placental abruption from endoscopic intubation, as well as by deleterious effects from transient intraprocedural maternal hypotension, hypoxia or cardiac arrhythmias. A further threat is posed by radiation exposure during ERCP, electrical injury during endoscopic electrocautery or electrocoagulation, and potential uterine hypoperfusion during epinephrine injection for hemostasis. Fetal toxicity from endoscopy can manifest itself at any time from the initial procedure to later in childhood. Manifestations might include premature delivery, stillbirth, low birth weight, neonatal illness, congenital malformations, or neurodevelopmental deficits.

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References

  1. Cappell MS (2003) The fetal safety and clinical efficacy of gastrointestinal endoscopy during pregnancy. Gastroenterol Clin North Am 32: 123–179

    Article  Google Scholar 

  2. Cappell MS et al. (1996) A study of eight medical centers of the safety and clinical efficacy of esophagogastroduodenoscopy in 83 pregnant females with follow-up of fetal outcome with comparison control groups. Am J Gastroenterol 91: 348–354

    CAS  PubMed  Google Scholar 

  3. Briggs GG et al. (2005) Drugs in pregnancy and lactation: A reference guide to fetal and neonatal risk, edn 7. Philadelphia: Lippincott, Williams & Wilkins

    Google Scholar 

  4. Jefferies JA et al. (1984) Structural anomalies of the cervix and vagina in women enrolled in the Diethylstilbestrol Adenosis (DESAD) Project. Am J Obstet Gynecol 148: 59–66

    Article  CAS  Google Scholar 

  5. Miller MT and Stromland K (1999) Teratogen update: thalidomide: a review, with a focus on ocular findings and new potential uses. Teratology 60: 306–321

    Article  CAS  Google Scholar 

  6. Cappell MS et al. (1996) A study at 10 medical centers of the safety and efficacy of 48 flexible sigmoidoscopies and 8 colonoscopies during pregnancy with follow-up of fetal outcome and with comparison to control groups. Dig Dis Sci 41: 2353–2361

    Article  CAS  Google Scholar 

  7. Jamidar PA et al. (1995) Endoscopic retrograde cholangiopancreatography in pregnancy. Am J Gastroenterol 90: 1263–1267

    CAS  PubMed  Google Scholar 

  8. Qureshi WA et al. (2005) ASGE Guideline: Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc 61: 357–362

    Article  Google Scholar 

  9. Freeman JM and Freeman AD (1992) Cerebral palsy and the 'bad baby' malpractice crisis. New York State shines light toward the end of the tunnel. Am J Dis Child 146: 725–727

    Article  CAS  Google Scholar 

  10. Yankowitz J (2003) Drugs in pregnancy. In Danforth's Obstetrics and Gynecology, edn 9, 129–142 (Eds Scott JR et al.) Philadelphia: Lippincott Williams & Wilkins

    Google Scholar 

Download references

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  1. Director of the Gastrointestinal Fellowship Training Program at the Albert Einstein Medical Center, PA, USA

    Mitchell S Cappell

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  1. Mitchell S Cappell
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Correspondence to Mitchell S Cappell.

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The author declares no competing financial interests.

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Cappell, M. Endoscopy in pregnancy: risks versus benefits. Nat Rev Gastroenterol Hepatol 2, 376–377 (2005). https://doi.org/10.1038/ncpgasthep0260

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