Post written by Hadie Razjouyan, MD, MPH, and GIE Senior Associate Editor Jennifer L. Maranki, MD, MSc, FASGE, from the Division of Gastroenterology and Hepatology, Penn State Health, Hershey, Pennsylvania, USA.

The focus of our study was the role, considerations, and safety of endoscopy in pregnant patients.

Gastroenterologists are frequently consulted in the care of pregnant patients who present with a variety of symptoms that may require endoscopic diagnosis and/or treatment. Endoscopy in pregnant patients is higher risk than in nonpregnant patients because the fetus is more sensitive to maternal hypotension and hypoxia, medications or ionizing radiation may cause teratogenesis, and there is a risk of premature birth.

Thus, pregnant patients benefit from endoscopic therapy in the least-invasive manner possible, and endoscopists must be aware of a number of important considerations when performing endoscopic procedures.

Balancing risks and benefits: The review highlights the importance of performing endoscopy only when the benefits clearly outweigh the risks to both mother and fetus.

Positioning and monitoring: The study adds to the knowledge base by noting the importance of patient positioning (left lateral or left pelvic tilt) to avoid aortocaval compression in the second and third trimesters. It also emphasizes the necessity of fetal heart rate monitoring before and after sedation, ideally with electronic fetal heart rate and uterine contraction monitoring after 24 weeks of gestation.

Medication and anesthesia: The article also provides guidance on medication choices, favoring Category B drugs and cautioning against benzodiazepines, especially in the first trimester. The review suggests anesthesia services should be strongly considered for deep sedation because of pregnancy-induced oropharyngeal edema and narrowing of the glottis opening.

Radiation exposure: The article offers detailed strategies for minimizing radiation exposure during ERCP, including adjusting patient positioning and using brief-pulse mode fluoroscopy and wire-guided techniques. It emphasizes that radiation exposure during ERCP is typically low but should still be minimized.

Post-ERCP pancreatitis risk: The review advises that ERCP in pregnancy may be associated with a higher risk of post-ERCP pancreatitis.

Multidisciplinary approach: The article underscores the importance of a multidisciplinary team, including obstetricians, experienced endoscopists, nurses, and anesthesia support, to ensure safe and effective care.

Future research directions: The study suggests that future research should focus on maternal conditions to better understand their impact on the safety and outcomes of endoscopic interventions. It also advocates for development of noninvasive diagnostic methods and long-term follow-up studies to assess developmental outcomes of children whose mothers underwent endoscopic procedures during pregnancy.

In conclusion, this article emphasizes the importance, safety, and efficacy of endoscopic procedures in properly selected patients through a multidisciplinary approach.

Supine versus left lateral positioning and its relation to the inferior vena cava and aorta.

Read the full article online.

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