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Gallstone and Biliary Disease

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Gastrointestinal and Liver Disorders in Women’s Health

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Abstract

Gallstone disease occurs more often in women than in men, and during pregnancy, women are at particular risk of developing gallstones. While the presence of gallstones alone does not mandate treatment beyond observation, recurrent symptomatic gallstones and complicated gallstones disease do require surgical consideration. In pregnant patients for whom cholecystectomy is indicated, timing depends upon trimester of pregnancy as well as the nature of the gallstone disease. The particular considerations that must be made for the pregnant patient in terms of diagnostic and treatment modalities as well as for surgical planning are discussed.

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References

  1. Schirmer BD, Winters KL, Edlich RF. Cholelithiasis and cholecystitis. J Long-Term Eff Med Implants. 2005;15(3):329–38.

    Article  Google Scholar 

  2. Carr BR, Simpson ER. Cholesterol synthesis by human fetal hepatocytes: effects of hormones. J Clin Endocrinol Metab. 1984;58(6):1111–6.

    Article  CAS  Google Scholar 

  3. Wang HH, Liu M, Clegg DJ, Portincasa P, Wang DQ-H. New insights into the molecular mechanisms underlying effects of estrogen on cholesterol gallstone formation. Biochim Biophys Acta Mol Cell Biol Lipids. 2009;1791(11):1037–47.

    Article  CAS  Google Scholar 

  4. Kern F, Everson GT. Contraceptive steroids increase cholesterol in bile: mechanisms of action. J Lipid Res. 1987;28(7):828–39.

    CAS  PubMed  Google Scholar 

  5. Kline L, Karpinski E. Progesterone inhibits gallbladder motility through multiple signaling pathways. Steroids. 2005;70(9):673–9.

    Article  CAS  Google Scholar 

  6. de Bari O, Wang TY, Liu M, Paik C-N, Portincasa P, Wang DQ-H. Cholesterol cholelithiasis in pregnant women: pathogenesis, prevention and treatment. Ann Hepatol. 2014;13(6):728–45.

    Article  Google Scholar 

  7. Ko CW, Beresford SAA, Schulte SJ, Matsumoto AM, Lee SP. Incidence, natural history, and risk factors for biliary sludge and stones during pregnancy. Hepatology. 2005;41(2):359–65.

    Article  Google Scholar 

  8. Tsimoyiannis EC, Antoniou NC, Tsaboulas C, Papanikolaou N. Cholelithiasis during pregnancy and lactation. Prospective study. Eur J Surg. 1994;160(11):627–31.

    CAS  PubMed  Google Scholar 

  9. Maringhini A, Ciambra M, Baccelliere P, Raimondo M, Orlando A, Tinè F, et al. Biliary sludge and gallstones in pregnancy: incidence, risk factors, and natural history. Ann Intern Med. 1993;119(2):116–20.

    Article  CAS  Google Scholar 

  10. Maringhini A, Marcenò MP, Lanzarone F, Caltagirone M, Fusco G, Di Cuonzo G, et al. Sludge and stones in gallbladder after pregnancy. Prevalence and risk factors. J Hepatol. 1987;5(2):218–23.

    Article  CAS  Google Scholar 

  11. Date RS, Kaushal M, Ramesh A. A review of the management of gallstone disease and its complications in pregnancy. Am J Surg. 2008;196(4):599–608.

    Article  CAS  Google Scholar 

  12. Ibiebele I, Schnitzler M, Nippita T, Ford JB. Outcomes of gallstone disease during pregnancy: a population-based data linkage study. Paediatr Perinat Epidemiol. 2017;31(6):522–30.

    Article  Google Scholar 

  13. Bouyou J, Gaujoux S, Marcellin L, Leconte M, Goffinet F, Chapron C, et al. Abdominal emergencies during pregnancy. J Visc Surg. 2015;152(6):S105–15.

    Article  CAS  Google Scholar 

  14. Augustin G, Majerovic M. Non-obstetrical acute abdomen during pregnancy. Eur J Obstet Gynecol Reprod Biol. 2007;131(1):4–12.

    Article  Google Scholar 

  15. Diegelmann L. Nonobstetric abdominal pain and surgical emergencies in pregnancy. Emerg Med Clin North Am. 2012;30(4):885–901.

    Article  Google Scholar 

  16. Keitel V, Dröge C, Stepanow S, Fehm T, Mayatepek E, Köhrer K, et al. Intrahepatic cholestasis of pregnancy (ICP): case report and review of the literature. Z Gastroenterol. 2016;54(12):1327–33.

    Article  CAS  Google Scholar 

  17. Larsson A, Palm M, Hansson L-O, Axelsson O. Reference values for clinical chemistry tests during normal pregnancy. BJOG. 2008;115(7):874–81.

    Article  CAS  Google Scholar 

  18. Abbassi-Ghanavati M, Greer LG, Cunningham FG. Pregnancy and laboratory studies. Obstet Gynecol. 2009;114(6):1326–31.

    Article  CAS  Google Scholar 

  19. Chang TS, Lepanto L. Ultrasonography in the emergency setting. Emerg Med Clin North Am. 1992;10(1):1–25.

    CAS  PubMed  Google Scholar 

  20. Melnick DM, Wahl WL, Dalton VK. Management of general surgical problems in the pregnant patient. Am J Surg. 2004;187(2):170–80.

    Article  Google Scholar 

  21. American College of Obstetricians and Gynecologists. Guidelines for diagnostic imaging during pregnancy and lactation [Internet]. ACOG Clinical Guidance and Publications. 2017. [Cited 10 Mar 2018]. https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Guidelines-for-Diagnostic-Imaging-During-Pregnancy-and-Lactation?IsMobileSet=false.

  22. Oto A, Ernst R, Ghulmiyyah L, Hughes D, Saade G, Chaljub G. The role of MR cholangiopancreatography in the evaluation of pregnant patients with acute pancreaticobiliary disease. Br J Radiol. 2009;82(976):279–85.

    Article  CAS  Google Scholar 

  23. Chen MM, Coakley FV, Kaimal A, Laros RK. Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstet Gynecol. 2008;112(2, Part 1):333–40.

    Article  Google Scholar 

  24. Cappell MS, Stavropoulos SN, Friedel D. Systematic review of safety and efficacy of therapeutic endoscopic-retrograde-cholangiopancreatography during pregnancy including studies of radiation-free therapeutic endoscopic-retrograde-cholangiopancreatography. World J Gastrointest Endosc. 2018;10(10):308–21.

    Article  Google Scholar 

  25. Tham TCK, Vandervoort J, Wong RCK, Montes H, Roston AD, Slivka A, et al. Safety of ERCP during pregnancy. Am J Gastroenterol. 2003;98(2):308–11.

    Article  CAS  Google Scholar 

  26. Shergill A, Ben-Menachem T, Chandrasekhara V, Chathadi K, Decker G, Evans J, et al. Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc. 2012;76(1):18–24.

    Article  Google Scholar 

  27. Magno-Pereira V, Moutinho-Ribeiro P, Macedo G. Demystifying endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy. Eur J Obstet Gynecol Reprod Biol. 2017;219:35–9.

    Article  Google Scholar 

  28. Shah JN, Bhat YM, Hamerski CM, Kane SD, Binmoeller KF. Feasibility of nonradiation EUS-based ERCP in patients with uncomplicated choledocholithiasis (with video). Gastrointest Endosc. 2016;84(5):764–9.

    Article  Google Scholar 

  29. Netinatsunton N, Sottisuporn J, Attasaranya S, Witeerungrot T, Siripun A, Pattarapuntakul T, et al. Prospective randomized trial of EUS-assisted ERCP without fluoroscopy versus ERCP in common bile duct stones. Gastrointest Endosc. 2017;86(6):1059–65.

    Article  Google Scholar 

  30. Dhupar R, Smaldone GM, Hamad GG. Is there a benefit to delaying cholecystectomy for symptomatic gallbladder disease during pregnancy? Surg Endosc. 2010;24(1):108–12.

    Article  Google Scholar 

  31. Hedström J, Nilsson J, Andersson R, Andersson B. Changing management of gallstone-related disease in pregnancy—a retrospective cohort analysis. Scand J Gastroenterol. 2017;52(9):1–6.

    Article  Google Scholar 

  32. Jorge AM, Keswani RN, Veerappan A, Soper NJ, Gawron AJ. Non-operative management of symptomatic cholelithiasis in pregnancy is associated with frequent hospitalizations. J Gastrointest Surg. 2015;19(4):598–603.

    Article  Google Scholar 

  33. Athwal R, Bhogal RH, Hodson J, Ramcharan S. Surgery for gallstone disease during pregnancy does not increase fetal or maternal mortality: a meta-analysis. Hepatobiliary Surg Nutr. 2016;5(1):53–7.

    PubMed  PubMed Central  Google Scholar 

  34. Paramanathan A, Walsh SZ, Zhou J, Chan S. Laparoscopic cholecystectomy in pregnancy: an Australian retrospective cohort study. Int J Surg. 2015;18:220–3.

    Article  Google Scholar 

  35. Sachs A, Guglielminotti J, Miller R, Landau R, Smiley R, Li G. Risk factors and risk stratification for adverse obstetrical outcomes after appendectomy or cholecystectomy during pregnancy. JAMA Surg. 2017;152(5):436.

    Article  Google Scholar 

  36. Guterman S, Mandelbrot L, Keita H, Bretagnol F, Calabrese D, Msika S. Laparoscopy in the second and third trimesters of pregnancy for abdominal surgical emergencies. J Gynecol Obstet Hum Reprod. 2017;46(5):417–22.

    Article  CAS  Google Scholar 

  37. Swisher SG, Schmit PJ, Hunt KK, Hiyama DT, Bennion RS, Swisher EM, et al. Biliary disease during pregnancy. Am J Surg. 1994;168(6):576–9; discussion 580–1.

    Article  CAS  Google Scholar 

  38. Hiatt JR, Hiatt JC, Williams RA, Klein SR. Biliary disease in pregnancy: strategy for surgical management. Am J Surg. 1986;151(2):263–5.

    Article  CAS  Google Scholar 

  39. Sedaghat N, Cao AM, Eslick GD, Cox MR. Laparoscopic versus open cholecystectomy in pregnancy: a systematic review and meta-analysis. Surg Endosc. 2017;31(2):673–9.

    Article  Google Scholar 

  40. Nasioudis D, Tsilimigras D, Economopoulos KP. Laparoscopic cholecystectomy during pregnancy: a systematic review of 590 patients. Int J Surg. 2016;27:165–75.

    Article  Google Scholar 

  41. Pearl JP, Price RR, Tonkin AE, Richardson WS, Stefanidis D. Guidelines for the use of laparoscopy during pregnancy—a SAGES publication [Internet]. Society of American Gastrointestinal and Endoscopic Surgeons. 2017. [Cited 10 Oct 2018]. https://www.sages.org/publications/guidelines/guidelines-for-diagnosis-treatment-and-use-of-laparoscopy-for-surgical-problems-during-pregnancy/.

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Authors and Affiliations

  1. Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Gillian L. Fell & David Brooks

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  1. Gillian L. Fell
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  2. David Brooks
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Correspondence to David Brooks .

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Editors and Affiliations

  1. Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA

    Poonam Beniwal-Patel

  2. Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA

    Reza Shaker

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Fell, G.L., Brooks, D. (2019). Gallstone and Biliary Disease. In: Beniwal-Patel, P., Shaker, R. (eds) Gastrointestinal and Liver Disorders in Women’s Health . Springer, Cham. https://doi.org/10.1007/978-3-030-25626-5_22

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  • DOI: https://doi.org/10.1007/978-3-030-25626-5_22

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-25625-8

  • Online ISBN: 978-3-030-25626-5

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