Dorottya Tarján, Eszter Ágnes Szalai, Bálint Erőss, Péter Jenő Hegyi, Vasile Liviu Drug, Serge Chooklin, Michael Hirth, Gabriel Sandblom, Vanessa Sandblom, Åsa Edergren, Ahmed Tlili, Sami Fendri, Simon Sirtl, Daniel de la Iglesia Gracía, Floreta Kurti, Dong Wu, Adriana Gherbon, Łukasz Nawacki, Alexandru Constantinescu, Natalia V Shirinskaya, Alexander N Zolotov, Sanjay Pandanaboyana, Tsukasa Ikeura, Tiago Cúrdia Gonçalves, Louise Rasmussen, Bodil Andersson, Ahmed Bouzid, Ahmed Saidani, Nándor Ács, Zoltán Sipos, Nelli Farkas, Balázs Tihanyi, Brigitta Teutsch, Johan Nilsson, Alexandra Mikó, Péter Hegyi
{"title":"Safety and Effectiveness of Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography in Biliary Pancreatitis During Pregnancy: BORN Study.","authors":"Dorottya Tarján, Eszter Ágnes Szalai, Bálint Erőss, Péter Jenő Hegyi, Vasile Liviu Drug, Serge Chooklin, Michael Hirth, Gabriel Sandblom, Vanessa Sandblom, Åsa Edergren, Ahmed Tlili, Sami Fendri, Simon Sirtl, Daniel de la Iglesia Gracía, Floreta Kurti, Dong Wu, Adriana Gherbon, Łukasz Nawacki, Alexandru Constantinescu, Natalia V Shirinskaya, Alexander N Zolotov, Sanjay Pandanaboyana, Tsukasa Ikeura, Tiago Cúrdia Gonçalves, Louise Rasmussen, Bodil Andersson, Ahmed Bouzid, Ahmed Saidani, Nándor Ács, Zoltán Sipos, Nelli Farkas, Balázs Tihanyi, Brigitta Teutsch, Johan Nilsson, Alexandra Mikó, Péter Hegyi","doi":"10.1002/ueg2.70121","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Biliary acute pancreatitis (AP) during pregnancy is a challenging situation, and current guidelines for AP, pregnancy care, and surgery do not specifically address its management. This study investigated the safety and effectiveness of cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy in AP.</p><p><strong>Methods: </strong>This international retrospective multicenter cohort study encompassed questions related to demographic information, clinical presentation, management strategies, timing of cholecystectomy, approaches to the procedure, complications, and outcomes. Continuous variables were summarized as medians with interquartile ranges, and categorical variables as frequencies and percentages. Group comparisons used Welch's t-test, Pearson's chi-squared, or Fisher's exact tests.</p><p><strong>Results: </strong>A total of 101 cases from 14 countries and 19 centers were enrolled. Cholecystectomy after mild AP during pregnancy had a lower rate of readmission due to recurrent AP or other gallstone-related complications compared with those who did not undergo surgery after a mild AP during pregnancy (0% vs. 24%; n = 0/17 vs. n = 12/49, p = 0.027). Cholecystectomy performed during pregnancy was associated with a low surgical complication rate, identical to that seen in postpartum procedures (12% vs. 10%; n = 2/17 vs. n = 3/30; p > 0.999). Preterm birth occurred in 7.1% (n = 1/14) of patients with cholecystectomy versus 11% (n = 5/45) without. Fetal loss after surgery occurred only in the first trimester (n = 3/17 vs. n = 1/49). No difference was seen in readmission (5%, n = 1/21 vs. 27%, n = 4/15; p = 0.138), fetal loss (5%, n = 1/21 vs. 27%, n = 4/15; p = 0.138) and preterm birth (6%, n = 1/17 vs. 8%, n = 1/12; p > 0.999) between the surgical and ERCP groups. The fetal loss (9.1%, n = 2/22 vs. 5.4%, n = 4/74; p = 0.618) and preterm birth rates (5.9%, n = 1/17 vs. 12%, n = 8/65; p = 0.677) did not significantly differ between patients with and without ERCP during pregnancy.</p><p><strong>Conclusion: </strong>Cholecystectomy is effective and safe in pregnant patients during the second or third trimester in cases of mild biliary pancreatitis. ERCP is safe in any trimester.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":6.7000,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"United European Gastroenterology Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/ueg2.70121","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Biliary acute pancreatitis (AP) during pregnancy is a challenging situation, and current guidelines for AP, pregnancy care, and surgery do not specifically address its management. This study investigated the safety and effectiveness of cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy in AP.
Methods: This international retrospective multicenter cohort study encompassed questions related to demographic information, clinical presentation, management strategies, timing of cholecystectomy, approaches to the procedure, complications, and outcomes. Continuous variables were summarized as medians with interquartile ranges, and categorical variables as frequencies and percentages. Group comparisons used Welch's t-test, Pearson's chi-squared, or Fisher's exact tests.
Results: A total of 101 cases from 14 countries and 19 centers were enrolled. Cholecystectomy after mild AP during pregnancy had a lower rate of readmission due to recurrent AP or other gallstone-related complications compared with those who did not undergo surgery after a mild AP during pregnancy (0% vs. 24%; n = 0/17 vs. n = 12/49, p = 0.027). Cholecystectomy performed during pregnancy was associated with a low surgical complication rate, identical to that seen in postpartum procedures (12% vs. 10%; n = 2/17 vs. n = 3/30; p > 0.999). Preterm birth occurred in 7.1% (n = 1/14) of patients with cholecystectomy versus 11% (n = 5/45) without. Fetal loss after surgery occurred only in the first trimester (n = 3/17 vs. n = 1/49). No difference was seen in readmission (5%, n = 1/21 vs. 27%, n = 4/15; p = 0.138), fetal loss (5%, n = 1/21 vs. 27%, n = 4/15; p = 0.138) and preterm birth (6%, n = 1/17 vs. 8%, n = 1/12; p > 0.999) between the surgical and ERCP groups. The fetal loss (9.1%, n = 2/22 vs. 5.4%, n = 4/74; p = 0.618) and preterm birth rates (5.9%, n = 1/17 vs. 12%, n = 8/65; p = 0.677) did not significantly differ between patients with and without ERCP during pregnancy.
Conclusion: Cholecystectomy is effective and safe in pregnant patients during the second or third trimester in cases of mild biliary pancreatitis. ERCP is safe in any trimester.
背景：妊娠期胆道性急性胰腺炎（AP）是一个具有挑战性的情况，目前的AP、妊娠护理和手术指南没有专门针对其管理。本研究调查了ap妊娠期胆囊切除术和内镜逆行胆管造影（ERCP）的安全性和有效性。方法：这项国际回顾性多中心队列研究包括与人口统计学信息、临床表现、管理策略、胆囊切除术时机、手术方法、并发症和结局相关的问题。连续变量概括为四分位数范围的中位数，分类变量概括为频率和百分比。组间比较采用韦尔奇t检验、皮尔逊卡方检验或费雪精确检验。结果：共有来自14个国家19个中心的101例病例入组。与妊娠期轻度AP后未行手术的患者相比，妊娠期轻度AP后行胆囊切除术的患者因复发性AP或其他胆结石相关并发症再入院率较低（0% vs. 24%; n = 0/17 vs. n = 12/49, p = 0.027）。妊娠期胆囊切除术的手术并发症发生率较低，与产后手术相同（12% vs. 10%; n = 2/17 vs. n = 3/30; p > 0.999）。早产儿发生率为7.1% (n = 1/14)，而未行胆囊切除术的早产儿发生率为11% （n = 5/45）。手术后胎儿丢失仅发生在妊娠早期（n = 3/17 vs. n = 1/49）。手术组和ERCP组在再入院（5%,n = 1/21 vs. 27%, n = 4/15; p = 0.138）、胎儿丢失（5%,n = 1/21 vs. 27%, n = 4/15; p = 0.138）和早产（6%,n = 1/17 vs. 8%, n = 1/12; p = 0.0.999）方面均无差异。妊娠期有无ERCP患者的胎儿丢失（9.1%,n = 2/22 vs. 5.4%, n = 4/74; p = 0.618）和早产率（5.9%,n = 1/17 vs. 12%, n = 8/65; p = 0.677）无显著差异。结论：对妊娠中晚期轻度胆源性胰腺炎患者行胆囊切除术是安全有效的。ERCP在任何妊娠期都是安全的。
期刊介绍：
United European Gastroenterology Journal (UEG Journal) is the official Journal of the United European Gastroenterology (UEG), a professional non-profit organisation combining all the leading European societies concerned with digestive disease. UEG’s member societies represent over 22,000 specialists working across medicine, surgery, paediatrics, GI oncology and endoscopy, which makes UEG a unique platform for collaboration and the exchange of knowledge.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
