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

Abstract

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.