Faigel, Douglas O.

Gallstone diseases are common during pregnancy. In most cases, patients are asymptomatic and do not require any treatment. However, choledocholithiasis, cholangitis, and gallstone pancreatitis may potentially become life‐threatening for both mother and fetus and often require urgent intervention. Although endoscopic retrograde cholangiopancreatography (ERCP) has become the standard technique for removing common bile duct stones, it is associated with ionizing radiation that could carry teratogenic risk. Non‐radiationERCP(NR‐ERCP) is reported to be effective without incurring this risk. Two techniques have been described to confirm bile duct cannulation: bile aspiration and image guidance. With bile aspiration, biliary cannulation is confirmed by applying suction to the cannula to yield bile, thus confirming an intrabiliary position. Image guidance involves using ultrasound or direct visualization (choledochoscopy) to confirm selective biliary cannulation or duct clearance. Once cannulation is achieved, the stones are removed using standardERCPtechniques and tools. Case series and retrospective studies have reported success rates of up to 90% forNR‐ERCPwith complication rates similar to standardERCP. Pregnancy outcomes are not adversely affected byNR‐ERCP, but whether the avoidance of radiation carries benefit for the baby is unknown. Prospective comparative trials are lacking.NR‐ERCPis technically demanding and should be attempted only by skilled biliary endoscopists in properly equipped and staffed health‐care institutions, in a multidisciplinary setting.