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Safety of high-carbohydrate fluid diet 2 h versus overnight fasting before non-emergency endoscopic retrograde cholangiopancreatography:A single-blind,multicenter,randomized controlled trial

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Chinese Medical Journal 2024年第12期137卷 1437-1446页

作者： Wenbo Meng Joseph W.Leung Zhenyu Wang Qiyong Li Leida Zhang Kai Zhang Xuefeng Wang Meng Wang Qi Wang Yingmei Shao Jijun Zhang Ping Yue Lei Zhang Kexiang Zhu Xiaoliang Zhu Hui Zhang Senlin Hou Kailin Cai Hao Sun Ping Xue Wei Liu Haiping Wang Li Zhang Songming Ding Zhiqing Yang Ming Zhang Hao Weng QingyuanWu Bendong Chen Tiemin Jiang Yingkai Wang Lichao Zhang Ke Wu Xue Yang Zilong Wen Chun Liu LongMiao Zhengfeng Wang Jiajia Li Xiaowen Yan Fangzhao Wang Lingen Zhang Mingzhen Bai Ningning Mi XianzhuoZhang Wence Zhou Jinqiu Yuan Azumi Suzuki Kiyohito Tanaka Jiankang Liu Ula Nur Elisabete Weiderpass Xun Li Department of General Surgery The First Hospital of Lanzhou UniversityLanzhouGansu 730000China Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province LanzhouGansu 730000China Division of Gastroenterology and Hepatology UC Davis Medical CenterSacramentoCA 95816USA Department of Minimally Invasive Surgery Tianjin Nankai HospitalTianjin 300100China Division of Hepatobiliary and Pancreatic Surgery Department of SurgeryShulan(Hangzhou)Hospital Affiliated to Zhejiang Shuren UniversityHangzhouZhejiang 310000China Department of Hepatobiliary Surgery Southwest HospitalArmy Medical UniversityChongqing 400000China Hepatobiliary Surgery Department Shandong Provincial Third HospitalJinanShandong 250000China Department of General Surgery Xinhua HospitalAffiliated to Shanghai Jiao Tong University School of MedicineShanghai Key Laboratory of Biliary Tract Disease ResearchShanghai 200000China Department of Hepatobiliary and Pancreatic Surgery The First Hospital of Jilin UniversityChangchunJilin 130000China Department of Hepatobiliary Surgery The General Hospital of Ningxia Medical UniversityYinchuanNingxia 750000China Department of Hepatobiliary&Hydatid Digestive and Vascular Surgery CenterXinjiang Key Laboratory of Echinococcosis and Liver Surgery ResearchThe First Affiliated Hospital of Xinjiang Medical UniversityUrumqiXinjiang 830000China Department of Hepatobiliary and Pancreatic Surgery The First Hospital of Shanxi Medical UniversityTaiyuanShanxi 030000China Department of General Surgery The Second Hospital of Lanzhou UniversityLanzhouGansu 730000China Department of Biliopancreatic endoscopic Surgery The Second Hospital of Hebei Medical UniversityShijiazhuangHebei 050000China Gastrointestinal Surgery Department Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei 430000China Department of Hepatobiliary Surgery The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anShaanxi 710000China Depart

Background:Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography(ERCP),the benefits and safety of high-carbohydrate fluid diet(CFD)intake 2 h before ERCP remain *** study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’***:This prospective,multicenter,randomized controlled trial involved 15 tertiary ERCP centers.A total of 1330 patients were randomized into CFD group(n=665)and fasting group(n=665).The CFD group received 400 mL of maltodextrin orally 2 h before ERCP,while the control group abstained from food/water overnight(>6 h)before *** ERCP procedures were performed using deep sedation with intravenous *** investigators were blinded but not the *** primary outcomes included postoperative fatigue and abdominal pain score,and the secondary outcomes included complications and changes in metabolic *** outcomes were analyzed according to a modified intention-to-treat ***:The post-ERCP fatigue scores were significantly lower at 4 h(4.1±2.6 vs.4.8±2.8,t=4.23,P<0.001)and 20 h(2.4±2.1 vs.3.4±2.4,t=7.94,P<0.001)in the CFD group,with least-squares mean differences of 0.48(95%confidence interval[CI]:0.26-0.71,P<0.001)and 0.76(95%CI:0.57-0.95,P<0.001),*** 4-h pain scores(2.1±1.7 vs.2.2±1.7,t=2.60,P=0.009,with a least-squares mean difference of 0.21[95%CI:0.05-0.37])and positive urine ketone levels(7.7%[39/509]vs.15.4%[82/533],χ^(2)=15.13,P<0.001)were lower in the CFD *** CFD group had significantly less cholangitis(2.1%[13/634]vs.4.0%[26/658],χ^(2)=3.99,P=0.046)but not pancreatitis(5.5%[35/634]vs.6.5%[43/658],χ^(2)=0.59,P=0.444).Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla(odds ratio[OR]:0.61,95%CI:0.39-0.95,P=0.028)in the multivariable ***:Ingesting 400 mL of CFD 2 h before ERCP is safe,with a reduction in post-ERCP fatigue,

关键词： endoscopic retrograde cholangiopancreatography ERCP Carbohydrate Fasting Safety Complications Enhanced recovery after surgery Randomized controlled trial

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Acute cholangitis with Achromobacter xylosoxidans bacteremia after endoscopic retrograde cholangiopancreatography in hilar cholangiocarcinoma:A case report

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World Journal of Clinical Cases 2024年第20期12卷 4377-4383页

作者： Ik Hyun Jo Sung Woo Ko Department of Internal Medicine St.Vincent’s HospitalCollege of MedicineThe Catholic University of KoreaSeoul 16471South Korea Department of Internal Medicine Eunpyeong St.Mary’s HospitalCollege of MedicineThe Catholic University of KoreaSeoul 03312South Korea

BACKGROUND Achromobacter xylosoxidans is a Gram-negative opportunistic aerobe,usually causing nosocomial infections in immunocompromised patients with manifestations including bacteremia,pneumonia,and catheter-related ***,*** have not yet been reported to cause biliary system *** SUMMARY A 72-year-old woman presented to the outpatient department of our hospital with a chief complaint of *** tomography of her abdomen revealed the presence of a mass of approximately 2.4 cm in the hilar portion of the common hepatic duct,consistent with hilar *** performed endoscopic retrograde cholangiopancreatography(ERCP)to decompress the obstructed left and right intrahepatic ducts(IHDs)and placed 10 cm and 11 cm biliary stents in the left and right IHDs,***,the day after the procedure,the patient developed post-ERCP cholangitis as the length of the right IHD stent was insufficient for proper bile *** blood culture of the patient tested positive for *** measures included the replacement of the right IHD stent(11 cm)with a longer one(12 cm)and administering culturedirected antibiotic therapy,solving the cholangitis-related *** the cholangitis had resolved,the patient underwent surgery for hilar cholangiocarcinoma and survived for 912 d without *** ***-induced biliary system infections are extremely *** awareness of physicians and endoscopists is required as this rare pathogen might cause infection after endoscopic procedures.

关键词： Achromobacter xylosoxidans Bacteremia Cholangitis endoscopic retrograde cholangiopancreatography Malignant biliary stricture Cholangiocarcinoma Case report

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Recognition and management of stent malposition in the portal vein during endoscopic retrograde cholangiopancreatography:A case report

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World Journal of Gastrointestinal Endoscopy 2024年第7期16卷 432-438页

作者： Rui Wu Feng Zhang Hao Zhu Ming-Dong Liu Yu-Zheng Zhuge Lei Wang Bin Zhang Department of Gastroenterology Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjing 210008Jiangsu ProvinceChina

BACKGROUND Portal vein injury is an uncommon complication of endoscopic retrograde cholangiopancreatography(ERCP),for which stent malpositioning in the portal vein is very rare and can lead to fatal *** report a case of biliary stent migration to the portal vein and a novel method for its safe removal under the guidance of portal ***,we reviewed the literature and summarized reports on the identification and management of this *** SUMMARY A 59-year-old woman with pancreatic cancer presented with abdominal pain and a high fever 20 days after the placement of two plastic biliary stents under the guidance of *** cultures and laboratory tests revealed sepsis,which was treated with antibiotics.A contrast-enhanced computed tomography scan revealed that one of the biliary stents in the main portal vein was *** safely remove the stent,portal angiography was performed to visualize the portal vein and to allow the management of any *** two stents were removed without obvious bleeding,and an uncovered self-expanding metal stent was placed in the common bile duct for *** patient had an uneventful 6-month follow-up period,except for self-resolving portal vein *** The combination of endoscopic and angiographic techniques allowed uneventful management of stent malposition in the portal vein.

关键词： endoscopic retrograde cholangiopancreatography Stent malposition Portal vein Portal angiography Case report

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Splenic subcapsular hematoma following endoscopic retrograde cholangiopancreatography:A case report and review of literature

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World Journal of Clinical Cases 2024年第24期12卷 5613-5621页

作者： Chen-Yu Guo Yu-Xia Wei Department of Gastroenterology Inner Mongolia Autonomous Region Hospital of Traditional Chinese MedicineHohhot 010000Inner Mongolia Autonomous RegionChina Graduate School Inner Mongolia Medical UniversityHohhot 010000Inner Mongolia Autonomous RegionChina

BACKGROUND Splenic injury following endoscopic retrograde cholangiopancreatography(ERCP)is a rare *** literature contains around 30 articles reporting various degrees of splenic injuries resulting from ERCP since the first report of splenic rupture after ERCP in *** SUMMARY This report describes a case of splenic hematoma and stent displacement in a 69-year-old male patient who developed these conditions 7 days after undergoing ERCP and *** patient had bile duct stenosis caused by a malignant tumor that was obstructing the bile *** diagnosis was confirmed by epigastric computed tomography and magnetic resonance *** patient was successfully treated with percutaneous transhepatic cholangial drainage,endoscopic pyloric stent placement,and conservative *** causes of splenic injury following ERCP are *** ERCP has the potential to cause splenic *** a patient experiences symptoms such as abdominal pain,decreased blood pressure,and altered hematology after the procedure,it's important to be thoroughly investigated for postoperative bleeding and splenic injury.

关键词： endoscopic retrograde cholangiopancreatography Gastroenterology Splenic injury Hematoma Case report

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Impact of frailty on endoscopic retrograde cholangiopancreatography outcomes in nonagenarians:A United States national experience

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World Journal of Gastrointestinal Endoscopy 2024年第3期16卷 148-156页

作者： Sanket Dhirubhai Basida Dushyant Singh Dahiya Muhammad Nadeem Yousaf Brinda Basida Bhanu Siva Mohan Pinnam Manesh Kumar Gangwani Hassam Ali Sahib Singh Yash R Shah Daksh Ahluwalia Mihir Prakash Shah Saurabh Chandan Neil R Sharma Shyam Thakkar Department of Internal Medicine University of Missouri-ColumbiaColumbiaMO 65212United States Division of Gastroenterology Hepatology&MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States Division of Gastroenterology and Hepatology University of MissouriColumbiaMO 65212United States Department of Rheumatology Medical College of GeorgiaAugusta UniversityNorth AugustaGA 30912United States Department of Internal Medicine John H.Stroger Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine The University of ToledoToledoOH 43606United States Division of Gastroenterology and Hepatology East Carolina University/Brody School of MedicineGreenvilleNC 27858United States Department of Internal Medicine Sinai HospitalBaltimoreMD 21215United States Department of Internal Medicine Trinity Health Oakland/Wayne State UniversityPontiacMI 48341United States Division of Gastroenterology and Hepatology Creighton University School of MedicineOmahaNE 68131United States Division of Interventional Oncology&Surgical Endoscopy GI Oncology Tumor Site TeamParkview Cancer InstituteParkview HealthFort WayneIN 46845United States Section of Gastroenterology&Hepatology West Virginia University School of MedicineMorgantownWV 26505United States

BACKGROUND endoscopic retrograde cholangiopancreatography(ERCP)is an essential therapeutic tool for biliary and pancreatic *** and elderly patients,especially those aged≥90 years are generally considered a higher-risk population for ERCP-related *** To investigate outcomes of ERCP in the Non-agenarian population(≥90 years)concerning *** This is a cohort study using the 2018-2020 National Readmission *** aged≥90 were identified who underwent ERCP,using the international classification of diseases-10 code with clinical *** Hopkins’s adjusted clinical groups frailty indicator was used to classify patients as frail and *** primary outcome was mortality,and the secondary outcomes were morbidity and the 30 d readmission rate related to *** used univariate and multivariate regression models for *** A total of 9448 patients were admitted for any indications of *** and non-frail patients were 3445(36.46%)and 6003(63.53%)*** for ERCP were Choledocholithiasis(74.84%),Biliary pancreatitis(9.19%),Pancreatico-biliary cancer(7.6%),Biliary stricture(4.84%),and Cholangitis(1.51%).Mortality rates were higher in frail group[adjusted odds ratio(aOR)=1.68,P=0.02].The Intra-procedural complications were insigni-ficant between the two groups which included bleeding(aOR=0.72,P=0.67),accidental punctures/lacerations(aOR=0.77,P=0.5),and mechanical ventilation rates(aOR=1.19,P=0.6).Post-ERCP complication rate was similar for bleeding(aOR=0.72,P=0.41)and post-ERCP pancreatitis(aOR=1.4,P=0.44).Frail patients had a longer length of stay(6.7 d vs 5.5 d)and higher mean total charges of hospitalization($78807 vs$71392)compared to controls(P<0.001).The 30 d all-cause readmission rates between frail and non-frail patients were similar(P=0.96).CONCLUSION There was a significantly higher mortality risk and healthcare burden amongst nonagenarian frail patients undergoing ERCP compared

关键词： endoscopic retrograde cholangiopancreatography Nonagenarians Frailty Mortality Healthcare burden

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Can early precut reduce post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with difficult bile duct cannulation?

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World Journal of Gastrointestinal Endoscopy 2024年第9期16卷 519-525页

作者： Tomohiro Tanikawa Keisuke Miyake Mayuko Kawada Katsunori Ishii Takashi Fushimi Noriyo Urata Nozomu Wada Ken Nishino Mitsuhiko Suehiro Miwa Kawanaka Hidenori Shiraha Ken Haruma Hirofumi Kawamoto Department of General Internal Medicine 2 Kawasaki Medical SchoolOkayama 7008505Japan

BACKGROUND endoscopic retrograde cholangiopancreatography(ERCP)is associated with a variety of adverse events(AEs).One of the most important AEs is post-ERCP pancreatitis(PEP),which is most common in cases of difficult biliary *** the precut technique has been reported as a PEP risk factor,recent studies indicate that early precut could reduce PEP,and that precut itself is not a risk *** To evaluate the safety of the precut technique,especially in terms of *** We conducted a retrospective study,spanning the period from November 2011 through December *** included 1556 patients,aged≥20 years,who underwent their initial ERCP attempt for biliary disease with a naïve papilla at the Kawasaki University General Medical *** compared the PEP risk between the early precut and the delayed precut *** The PEP incidence rate did not significantly differ between the precut and nonprecut ***,the PEP incidence was significantly lower in the early precut group than the delayed precut group(3.5%vs 10.5%;P=0.02).The PEP incidence in the delayed precut group without pancreatic stent insertion(17.3%)was significantly higher compared to other cases(P<0.01).CONCLUSION Our findings indicate that early precut may reduce PEP *** the precut decision is delayed,a pancreatic stent should be inserted to prevent PEP.

关键词： endoscopic retrograde cholangiopancreatography Post-endoscopic retrograde cholangiopancreatography pancreatitis Precut Needle-knife precut papillotomy

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endoscopic retrograde cholangiopancreatography for diagnosing and treating pediatric biliary and pancreatic diseases

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World Journal of Gastrointestinal Surgery 2023年第10期15卷 2272-2279页

作者： Xiu-Min Qin Fei-Hong Yu Chuan-Kai Lv Zhi-Min Liu Jie Wu Department of Gastroenterology Beijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijing 100045China Department of Ultrasound Beijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijing 100045China Department of Radiology Beijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijing 100045China

BACKGROUND This study evaluated the safety and effectiveness of endoscopic retrograde cholangiopancreatography(ERCP)in pediatric patients with biliary and pancreatic diseases.A retrospective analysis was conducted on 57 ERCP procedures performed in 41 children,primarily for treating pancreatic *** overall success rate was 91.2%,with no major complications ***-ERCP pancreatitis(PEP)occurred in 8.8%of ***-up examinations over one year showed no recurrence of biliary or pancreatic ***,endoscopic treatment led to a significant increase in body mass index(BMI).These findings demonstrate the valuable role of ERCP in managing such *** To evaluate the safety and efficacy of ERCP for the management of biliary and pancreatic diseases in pediatric *** We conducted a retrospective analysis of data from children aged 1-18 years who underwent ERCP for biliary and pancreatic diseases at Beijing Children’s Hospital between January 2021 and December *** collected data included procedure time,endoscopic treatment,success rate,and postoperative *** Forty-one children underwent 57 ERCP procedures,including 14 with biliary duct disease and 27 with pancreatic *** mean age of the patients was 7.48±3.48 *** duct-related treatments were performed 18 times,and pancreatic disease treatments were performed 39 *** was primarily used to treat pediatric pancreatic diseases[68.4%(39/57)of the procedures].The overall success rate was 91.2%(52/57 patients).PEP was noted in five patients(8.8%,5/57),and no instances of bleeding,perforation,or cholangitis were *** patients were followed up for over one year,and no recurrence of biliary or pancreatic diseases was ***,BMI significantly increased after endoscopic treatment compared to that before treatment(P=0.001).CONCLUSION The high success rate and lack of major complications support the valuable role of ERCP in the

关键词： Pediatric endoscopic retrograde cholangiopancreatography Choledocholithiasis Chronic pancreatitis Pancreatic ducts Postoperative complications

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endoscopic retrograde cholangiopancreatography in pancreatic and biliary tract disease in Korean children

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World Journal of Gastroenterology 2010年第4期16卷 490-495页

作者： Joo Young Jang Chong Hyun Yoon Kyung Mo Kim Department of Pediatrics Asan Medical Center Children's HospitalUniversity of Ulsan College of MedicineSeoul 138-736South Korea Department of Pediatrics Ajou University School of MedicineSuwon 443-721South Korea Department of Pediatric Radiology Asan Medical Center Children's HospitalUniversity of Ulsan College of MedicineSeoul 138-736South Korea Department of Pediatrics Asan Medical Center Children’s HospitalUniversity of Ulsan College of MedicineSeoul 138-736South Korea

AIM:To assess the indications,findings,therapeutic procedures,safety,and complications of endoscopic retrograde cholangiopancreatography(ERCP) performed in Korean ***:The demographic characteristics,indications for ERCP,findings,therapeutic procedures,and complications of 122 pediatric patients who underwent 245 ERCPs in the Asan Medical Center between June 1994 and March 2008 were ***:The mean age of the 122 patients was 8.0 ± 4.2 *** were biliary pathology in 78(64.0%),pancreatic pathology in 43(35.2%),and chronic abdominal pain in *** indications included choledochal cysts in 40,choledocholithiasis in 24,suspected sclerosing cholangitis in 8,trauma in 2,and other conditions in *** indications includedacute pancreatitis in 7,acute recurrent pancreatitis in 11,chronic pancreatitis in 20,trauma in 3,and pancreatic mass in *** the 245 ERCPs,success rate was 98.4% and 190(77.6%) were for therapeutic purposes,including endoscopic nasal drainage(51.8%),biliary sphincterotomy(38.0%),pancreatic sphincterotomy(23.3%),stent insertion(15.1%),stone extraction(18.8%),and balloon dilatation(11.0%).Complications were postERCP pancreatitis in 16(6.5%),ileus in 23(9.4%),hemorrhage in 2(0.8%),perforation in 2(0.8%),sepsis in 1(0.4%),and impacted basket in 1(0.4%).There were no procedure-related deaths,and most complications improved under supportive ***:This study showed that there is a high incidence of choledochal cyst and diagnostic and therapeutic ERCP for the management of various biliary and pancreatic diseases was safe and effective in Korean children.

关键词： endoscopic retrograde cholangiopancreatography Pancreatic diseases Biliary tract diseases Choledochal cyst Pancreatitis Pediatrics

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endoscopic retrograde cholangiopancreatography for bile duct stones in patients with a performance status score of 3 or 4

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World Journal of Gastrointestinal Endoscopy 2022年第4期14卷 215-225页

作者： Hirokazu Saito Yoshihiro Kadono Takashi Shono Kentaro Kamikawa Atsushi Urata Jiro Nasu Haruo Imamura Ikuo Matsushita Tatsuyuki Kakuma Shuji Tada Department of Gastroenterology Kumamoto City HospitalKumamoto City 862-8505Japan Department of Gastroenterology Tsuruta HospitalKumamoto City 862-0925Japan Department of Gastroenterology Kumamoto Chuo HospitalKumamoto City 862-0965Japan Department of Gastroenterology Saiseikai Kumamoto HospitalKumamoto City 861-4193Japan Department of Gastroenterological Surgery Kumamoto Chuo HospitalKumamoto City 862-0965Japan Department of Biostatics Kurume UniversityKurume City 8300011Japan

BACKGROUND As the aging population grows worldwide,the rates of endoscopic retrograde cholangiopancreatography(ERCP)for common bile duct stones(CBDS)in older patients with a poor performance status(PS)have been ***,the data on the safety and efficacy of ERCP for CBDS in patients with a PS score of 3 or 4 are lacking,with only a few studies having investigated this issue among patients with poor *** To examine the safety and efficacy of ERCP for CBDS in patients with a PS score of 3 or *** This study utilized a retrospective multi-centered design of three institutions in Japan for 8 years to identify a total of 1343 patients with CBDS having native papillae who underwent therapeutic *** a result,1113 patients with a PS 0-2 and 230 patients with a PS 3-4 were ***-to-one propensity-score matching was performed to compare the safety and efficacy of ERCP for CBDS between patients with a PS 0-2 and those with a PS *** The overall ERCP-related complication rates in all patients and propensity score-matched patients with a PS 0-2 and 3-4 were 9.0%(100/1113)and 7.0%(16/230;P=0.37),and 4.6%(9/196)and 6.6%(13/196;P=0.51),*** the propensity score-matched patients,complications were significantly more severe in the group with a PS 3-4 than in the group with a PS 0-2 group(P=0.042).Risk factors for complications were indications of ERCP and absence of antibiotics in the multivariate *** success rates,including complete CBDS removal and permanent biliary stent placement,in propensity score-matched patients with a PS 0-2 and 3-4 were 97.4%(191/196)and 97.4%(191/196),respectively(P=1.0).CONCLUSION ERCP for CBDS can be effectively performed in patients with a PS 3 or ***,the indication for ERCP in such patients should be carefully considered with prophylactic antibiotics.

关键词： endoscopic retrograde cholangiopancreatography Complication Performance status Risk factor

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endoscopic retrograde cholangiopancreatography during pregnancy without radiation

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World Journal of Gastroenterology 2009年第29期15卷 3649-3652页

作者： Adem Akcakaya Orhan Veli Ozkan Ismail Okan Orhan Kocaman Mustafa Sahin 1st Department of General Surgery Vakif Gureba Research and Training Hospital 34093 Istanbul Turkey Department of General Surgery Faculty of Medicine Mustafa Kemal University 31100 Hatay Turkey Gastroenterology Division of Medical Faculty Hospital Kocaeli University 41380 Kocaeli Turkey

AIM： To present our experience with pregnant patients who underwent endoscopic retrograde cholangiopancreatography （ERCP） without using radiation, and to evaluate the acceptability of this alternative therapeutic pathway for ERCP during pregnancy. METHODS： Between 2000 and 2008, six pregnant women underwent seven ERCP procedures. ERCP was performed under mild sedoanalgesia induced with pethidine HCI and midazolam. The bile duct was cannulated with a guidewire through the papilla. A catheter was slid over the guidewire and bile aspiration and/or visualization of the bile oozing around the guidewire was used to confirm correct cannulation. Following sphincterotomy, the bile duct was cleared by balloon sweeping. When indicated, stents were placed. Confirmation of successful biliary cannulation and stone extraction was made by laboratory, radiological and clinical improvement. Neither fluoroscopy nor spot radiography was used during the procedure. RESULTS： The mean age of the patients was 28 years （range, 21-33 years）. The mean gestational age for the fetus was 23 wk （range, 14-34 wk）. Five patients underwent ERCP because of choledocholithiasis and/or choledocholithiasis-induced acute cholangitis. In one case, a stone was extracted after precut papillotomy with a needle-knife, since the stone was impacted. One patient had ERCP because of persistent biliary fistula after hepatic hydatid disease surgery. Following sphincterotomy, scoleces were removed from the common bile duct. Two weeks later, because of the absence of fistula closure, repeat ERCP was performed and a stent was placed. The fistula was closed after stent placement. Neither post-ERCP complications nor premature birth or abortion was seen. CONCLUSION： Non-radiation ERCP in experienced hands can be performed during pregnancy. Stent placement should be considered in cases for which complete common bile duct clearance is dubious because of a lack of visualization of the biliary tree.

关键词： Cholangitis Choledocholithiasis endoscopic retrograde cholangiopancreatography Jaundice Pregnancy

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