Abstract

Background and Aims: Endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy is indicated for symptomatic biliary obstruction, cholangitis, and gallstone pancreatitis. Although fetal radiation exposure during standard ERCP is typically below teratogenic thresholds, minimizing radiation adheres to the ALARA principle. We report a case series of three pregnant patients who underwent ultrasound-guided ERCP without fluoroscopy and propose a standardized technical approach. Methods: Three pregnant patients with symptomatic biliary obstruction underwent radiation-free ERCP using wire-guided cannulation with real-time transabdominal ultrasound confirmation of guidewire placement and duct clearance. Results: All three procedures were technically successful without the use of fluoroscopy. Complete duct clearance was achieved in all cases. No maternal procedural complications occurred. Fetal monitoring before and after the procedure was reassuring in all patients. All pregnancies progressed without adverse events. Conclusions: Ultrasound-guided ERCP without fluoroscopy is feasible and safe in selected pregnant patients when performed by experienced endoscopists with multidisciplinary support. This technique eliminates fetal radiation exposure while maintaining therapeutic efficacy.

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