Long-term follow-up after fetal radiation exposure during endoscopic retrograde cholangiopancreatography

Abstract

Background and study aims The main concern about endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy is the risk of radiation exposure to the fetus. The potential exists not only in the short-term, but also in the long-term and includes growth and development problems and the possibility of childhood cancer. Little is known about the long-term effects of fetal radiation exposure at the time of ERCP. The aim of the study was to report the long-term outcome of babies born after radiation exposure to mothers who underwent ERCP during pregnancy.

Patients and methods This was a single-center retrospective cohort study. We included 24 consecutive pregnant patients who underwent ERCP due to choledocholithiasis and their children, between June 1997 and June 2015. All patients and their babies were followed up until birth to assess their short-term outcome. To assess long-term outcomes, from September 2014 to September 2015, a comprehensive medical interview was conducted with the mothers and their children. We also evaluated medical records, lab tests, school report cards, and the families completed a questionnaire inquiring about perceived health status of the children.

Results Fifteen patients had full-term pregnancies. One patient had a preterm delivery (32 weeks) due to preeclampsia. There were no cases of miscarriage, stillbirth or fetal malformations. Long-term follow-up was performed at a mean age of 11.08 years (range 1–18) for the children, with no developmental delays, poor school performance, or malignancies found.

Conclusions Long-term outcome in children born after radiation exposure during ERCP was unremarkable.

Publication History

Received: 27 July 2020

Accepted: 29 September 2020

Article published online:
27 November 2020

• References

• 1 Buxbaum JL, Abbas Fehmi SM, Sultan S. et al. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc 2019; 89: 1075-1105
• 2 Manes G, Paspatis G, Aabakken L. et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2019; 51: 472-491
• 3 Ducarme G, Maire F, Luton D. et al. Acute pancreatitis during pregnancy: a review. Journal Perinatol 2014; 34: 87-94
• 4 Othman MO, Stone E, Hashimi M. et al. Conservative management of cholelithiasis and its complications in pregnancy is associated with recurrent symptoms and more emergency department visits. Gastrointest Endosc 2012; 76: 564-569
• 5 Kahaleh M, Hartwell GD, Arseneau KO. et al. Safety and efficacy of ERCP in pregnancy. Gastrointest Endosc 2004; 60: 287-292
• 6 Baillie J, Cairns SR, Putman WS. et al. Endoscopic management of choledocholithiasis during pregnancy. Surg Gynecol Obstet 1990; 171: 1-4
• 7 Tang SJ, Mayo MJ, Rodriguez-Frías E. et al. Safety and utility of ERCP during pregnancy. Gastrointest Endosc 2009; 69: 453-461
• 8 Fine S, Beirne J, Delgi-Esposti S. et al. Continued evidence for safety of endoscopic retrograde cholangiopancreatography during pregnancy. World J Gastrointest Endosc 2014; 6: 352-358
• 9 Tham TC, Vandervoort J, Wong RC. et al. Safety of ERCP during pregnancy. Am J Gastroenterol 2003; 98: 308-311
• 10 Baron T, Schueler B. Pregnancy and radiation exposure during therapeutic ERCP: time to put the baby to bed?. Gastrointest Endosc 2009; 69: 832-834
• 11 Williams PM, Fletcher S. Health effects of prenatal radiation exposure. Am Fam Physician 2010; 82: 488-493
• 12 Streffer C, Shore R, Konermann G. et al. Biological effects after prenatal irradiation (embryo and fetus). A report of the International Commission on Radiological Protection. Ann ICRP 2003; 33: 5-206
• 13 De Santis M, Cesari E, Nobili E. et al. Radiation effects on development. Birth Defects Res C Embryo Today 2007; 81: 177-182
• 14 Lee S, Otake M, Schull WJ. Changes in the pattern of growth in stature related to prenatal exposure to ionizing radiation. Int J Radiat Biol 1999; 75: 1449-1458
• 15 Schull WJ. Brain damage among individuals exposed prenatally to ionizing radiation: a 1993 review. Stem Cells 1997; 15: 129-133
• 16 Mole RH. Childhood cancer after prenatal exposure to diagnostic X-ray examinations in Britain. Br J Cancer 1990; 62: 152-168
• 17 Cappell M, Stavropoulos SN, Friedel D. Systematic review of safety and efficacy of therapeutic endoscopic-retrograde-cholagiopancreatography during pregnancy including studies of radiation-free therapeutic endoscopic-retrograde-cholangiopancreatography. World J Gastrointest Endosc 2018; 10: 308-321
• 18 International Commission on Radiological Protection. ICRP, 2000. Pregnancy and Medical Radiation. ICRP Publication 84. Ann ICRP 2000; 30: 1
• 19 ACOG Committee on Obstetric Practice. Guidelines for diagnostic imaging during pregnancy. ACOG Opinion Number 299. Obstet Gynecol 2004; 104: 647-651
• 20 McCollough CH, Schueler BA, Atwell TD. et al. Radiation exposure and pregnancy: when should we be concerned?. Radiographics 2007; 27: 909-917
• 21 Schulze-Rath R, Hammer GP, Blettner M. Are pre- or postnatal diagnostic X-rays a risk factor for childhood cancer?. A systematic review. Radiat Environ Biophys 2008; 47: 301-312
• 22 Centers for Disease Control and Prevention. Radiation and pregnancy: a fact sheet for clinicians. Available at (Accessed May 2020): http://www.bt.cdc.gov/radiation/prenatalphysician.asp
• 23 Smith I, Gaidhane M, Goode A. et al. Safety of endoscopic retrograde cholangiopancreatography in pregnancy: Fluoroscopy time and fetal exposure, does it matter?. World J Gastrointest Endosc 2013; 5: 148-152
• 24 Samara E, Stratakis J, Enele Melono J. et al. Therapeutic ERCP and pregnancy: is the radiation risk for the conceptus trivial?. Gastrointest Endosc 2009; 69: 824-830
• 25 Huda A, Garzón WJ, Filho GCL. et al. Evaluation of staff, patient and foetal radiation doses due to endoscopic retrograde cholanigiopancreatography (ERCP) procedures in a pregnant patient. Radiation Protection Dosimetry 2015; October: 1-7
• 26 Dumonceau JM, García-Fernández FJ, Verdún FR. et al. Radiation protection in digestive endoscopy: European Society of Digestive Endoscopy (ESGE) Guideline. Endoscopy 2012; 44: 408-424
• 27 Ackakaya A, Ozkan O, Orhan I. et al. Endoscopic retrograde cholangiopancreatography during pregnancy without radiation. World J Gastroenterol 2009; 15: 3649-3652
• 28 Azab M, Bharadwaj S, Jayaraj M. et al. Safety of endoscopic retrograde cholangiopancreatography (ERCP) in pregnancy. A systematic review and meta-analysis. Saudi J Gastroenterol 2019; 25: 341-354
• 29 Gupta R, Tandam M, Lakhtakia S. et al. Safety of therapeutic ERCP in pregnancy – an Indian experience. Indian J Gastroenterol 2005; 24: 161-163
• 30 Konduk BT, Bayraktar O. Efficacy and safety of endoscopic retrograde cholangiopancreatography in pregnancy: A high-volume study with long-term follow up. Turk J Gastroenterol 2019; 30: 811-816
• 31 Larkin CJ, Workman A, Wright R. et al. Radiation doses to patients during ERCP. Gastrointestinal Endoscopy 2001; 53: 161-164
• 32 Shergill AK, Ben-Menachem T, Sharaf R. et al. ASGE Guideline: guidelines for endoscopy in pregnant and lactating women. Gastrointestinal Endoscopy 2005; 61: 357-362
• 33 Abou-Ghannam G, Usta I, Nassar A. Indomethacin in pregnancy: Applications and safety. Am J Perinatol 2012; 29: 175-186
• 34 Londero A, Rossetti E, Pittini C. et al. Maternal age and the risk of adverse pregnancy outcomes: a retrospective cohort study. BMC Preg Childbirth 2019; 19: 1-10
• 35 García-Cano J, Pérez-Miranda M, Perez-Roldán F. et al. ERCP during pregnancy. Rev Esp Enferm Dig 2012; 104: 53-58