Conservative management of cholelithiasis and its complications in pregnancy is associated with recurrent symptoms and more emergency department visits

Background: Pancreaticobiliary complications of gallstones are common in pregnancy and can result in serious sequelae. Previous studies have shown conflicting results regarding different approaches of treatment. Objective: To compare the outcomes of conservative treatment versus operative and endoscopic interventions in the management of complications related to gallstones during pregnancy. Design: Retrospective chart review. Setting: Tertiary-care referral facility. Patients: A total of 112 patients who had complications related to gallstones during pregnancy. Intervention: Patients were classified into 3 groups: conservative treatment, laparoscopic cholecystectomy (LC), and ERCP. Main Outcome Measurements: We collected demographic data and information regarding treatment complications and pregnancy outcomes. Results: A total of 112 pregnant patients met the inclusion criteria, with a mean age of 25 years. Main clinical presentations were biliary colic (n = 56), biliary pancreatitis (n = 27), acute cholecystitis (n = 17), and choledocholithiasis (n = 12). A total of 68 patients underwent conservative treatment, 13 patients underwent ERCP, 27 patients had LC, and 4 patients received both ERCP and LC. Recurrent biliary symptoms were significantly more common in patients who received conservative treatment (P = .0005). The number of emergency department visits was significantly higher in the conservative treatment group compared with the active intervention group (P = .0006). The number of hospitalizations also was higher in the conservative treatment group (P = .03). Fetal birth weight was similar in both groups (P = .1). Patients treated conservatively were more likely to undergo cesarean section operations for childbirth (P = .04). Limitations: Single-center, retrospective study. Conclusion: Conservative treatment of cholelithiasis and its complications during pregnancy is associated with recurrent biliary symptoms and frequent emergency department visits. ERCP and LC are safe alternative approaches during pregnancy. (Gastrointest Endosc 2012;76:564-9.)