jueves, 1 de octubre de 2015

Mas de pancreatitis y embarazo/More on Pregnacy and pancreatitis

Octubre 1, 2015. No. 2101
Anestesia y Medicina del Dolor

Pancreatitis y embarazo
Colecistectomía laparoscópica en embarazadas: experiencia de 5 años en el Hospital General de México
Laparoscopic cholecystectomy in pregnant patient: experience in hospital General de Mexico in a period of 5 years (2008-2012)
Ginecol Obstet Mex. 2014 Aug;82(8):509-17.
BACKGROUND: Cholecystitis is the second cause of abdominal pain during pregnancy. 1-8 of 10,000 requiring surgery, being performed in the first and second quarter laparoscopically. 100% of patients with cholecystitis, about 12% are associated with pancreatitis with high rates of maternal and fetal morbidity and mortality. OBJECTIVE: To evaluate advantages--disadvantages of maternal-fetal pregnancy laparoscopic cholecystectomy and its preventive character avoiding cases of pancreatitis. We analyze the results obtained in Perinatology Service in General Hospital of Mexico (2008 to 2012) comparing them with the current literature. MATERIAL AND METHODS: A retrospective, cross sectional, descriptive. Analyzing the following variables: maternal age, gestational age, number of gestations, surgical technique, and postoperative complications trans, maternal and perinatal morbidity, gallbladder colic episodes prior, liver ultrasound report--bile ducts, tocolytic management. RESULTS: 20 laparoscopic cholecystectomies were performed in pregnant patients. Maternal age 21-38 years, mostly multigesta. 5 patients was performed at weeks 9, 14, 20 and 25 between the SDG and 1 at 27.5 SDG.Vesicular colicky eight previous USG mostly with gallstones.Two cases of mild acute pancreatitis satisfactorily resolved. No trans or postoperative complications. Open technique for performing pneumoperitoneum (Hasson). Tocolytic management indomethacin in 100% of cases. CONCLUSIONS: The results obtained are consistent with the current literature, confirming that laparoscopic cholecystectomy is the best treatment option with minimal fetal maternal morbidity, reducing the incidence of pancreatitis and maternal- fetal consequences.
Endoscopía gastrointestinal en la embarazada
Gastrointestinal endoscopy in the pregnant woman.
World J Gastrointest Endosc. 2014 May 16;6(5):156-67. doi: 10.4253/wjge.v6.i5.156.
About 20000 gastrointestinal endoscopies are performed annually in America in pregnant women. Gastrointestinal endoscopy during pregnancyraises the critical issue of fetal safety in addition to patient safety. Endoscopic medications may be potentially abortifacient or teratogenic. Generally, Food and Drug Administration category B or C drugs should be used for endoscopy. Esophagogastroduodenoscopy (EGD) seems to be relatively safe for both mother and fetus based on two retrospective studies of 83 and 60 pregnant patients. The diagnostic yield is about 95% when EGD is performed for gastrointestinal bleeding. EGD indications during pregnancy include acute gastrointestinal bleeding, dysphagia > 1 wk, or endoscopic therapy. Therapeutic EGD is experimental due to scant data, but should be strongly considered for urgent indications such as active bleeding. One study of 48 sigmoidoscopies performed during pregnancy showed relatively favorable fetal outcomes, rare bad fetal outcomes, and bad outcomes linked to very sick mothers. Sigmoidoscopy should be strongly considered for strong indications, including significant acute lower gastrointestinal bleeding, chronic diarrhea, distal colonic stricture, suspected inflammatory bowel disease flare, and potential colonic malignancy. Data on colonoscopy during pregnancy are limited. One study of 20 pregnant patients showed rare poor fetal outcomes. Colonoscopy is generally experimental during pregnancy, but can be considered for strong indications: known colonic mass/stricture, active lower gastrointestinal bleeding, or colonoscopic therapy. Endoscopic retrograde cholangiopancreatography (ERCP) entails fetal risks from fetal radiation exposure. ERCP risks to mother and fetus appear to be acceptable when performed for ERCP therapy, as demonstrated by analysis of nearly 350 cases during pregnancy. Justifiable indications include symptomatic or complicated choledocholithiasis, manifested by jaundice, cholangitis, gallstone pancreatitis, or dilated choledochus. ERCP should be performed by an expert endoscopist, with informed consent about fetal radiation risks, minimizing fetal radiation exposure, and using an attending anesthesiologist. Endoscopy is likely most safe during the second trimester of pregnancy.
KEYWORDS: Colonoscopy; Endoscopic complications; Endoscopic indications; Endoscopic retrograde cholangiopancreatography; Endoscopy safety; Esophagogastroduodenoscopy; Flexible sigmoidoscopy; Gastrointestinal endoscopy; Pregnancy; Teratogenicity
Colangiopancreatografía retrograda endoscópica en el embarazo. ¿Es segura?
ERCP in pregnancy: is it safe?
Gastroenterol Hepatol (N Y). 2009 Dec;5(12):851-5.
BACKGROUND: Although rare, pancreaticobiliary disease during pregnancy can pose a serious risk to both the mother and fetus. Data regarding the relative safety of endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy are sparse. METHODS: We performed a retrospective review of 17 ERCP procedures performed at a single tertiary care referral center between January 2005 and April 2009. Records were reviewed for ERCP indication, endoscopic interventions, use and extent of fluoroscopy, postprocedure complications, and pregnancy outcomes including Apgar scores. RESULTS: All procedures were performed without any maternal adverse events immediately or on follow-up. There were no signs of fetal distress during any of these cases, and there were no fetal complications noted upon delivery or at 30-day follow-up per chart review. CONCLUSION: Therapeutic ERCP during pregnancy appears to be safe when performed in experienced hands and
Eficacia y seguridad de procedimientos endoscópicos pancreatobiliares durante el embarazo
Efficacy and Safety of Pancreatobiliary Endoscopic Procedures during Pregnancy.
Gut Liver. 2015 Sep 23;9(5):672-8. doi: 10.5009/gnl14217.
BACKGROUND/AIMS: Endoscopic therapy with endoscopic retrograde cholangiopancreatography (ERCP) has been suggested as an effective diagnostic and therapeutic tool for biliary and pancreatic disorders during pregnancy. In this report, we describe our experiences with pancreatobiliary endoscopic procedures during pregnancy. METHODS: We reviewed ERCP and endoscopic ultrasonography (EUS) procedures that were performed at a single tertiary care referral center between January 2002 and October 2013. Medical records were reviewed for the procedure indication, the duration of fluoroscopy, postprocedure complications, etc. Pregnancy outcomes and fetal complications were identified by chart review and phone calls to patients. RESULTS: A total of 10 ERCPs and five EUSs were performed in 13 pregnant patients four of whom underwent the procedure in the first trimester, eight in the second trimester, and one in the third trimester. Indications for endoscopic therapy included gallstone pancreatitis, obstructive jaundice with common bile duct (CBD) stone, asymptomatic CBD stone, pancreatic cyst, choledochal cyst, and acute cholecystitis. Only one patient had a complication, which was postprocedural hyperamylasemia. Two patients underwent an artificial abortion, one according to her own decision and the other due to an adverse drug reaction. CONCLUSIONS: ERCP seems to be effective and safe for pregnant women. Additionally, EUS can be an alternative to ERCP during pregnancy.
KEYWORDS: Cholangiopancreatography, endoscopic retrograde; Endosonography; Fetus; Pregnancy
Modulo CEEA Leon, Gto. Curso CEEA Tijuana  XII Congreso Virtual Mexicano de Anestesiologia

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