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Background: ERCP is an important diagnostic and therapeutic tool in patients with biliary and pancreatic disease. Its utility and safety during pregnancy is largely unknown because it is not often required and because its use has been only infrequently reported in the published literature. Objective: Our purpose was to report the clinical experience with ERCP during pregnancy. Design: Retrospective review, single academic center. Patients: All (consecutive) pregnant women who underwent ERCP at Parkland Memorial Hospital from 2000 to 2006. Main Outcome Measurements: History, clinical data, hospital course, procedure-related complication rates and outcomes, and delivery and fetal outcomes were abstracted from medical records. Results: During the study period, 68 ERCPs were performed on 65 pregnant women. The calculated ERCP rate was 1 per 1415 births. The common indications for ERCP in pregnancy were recurrent biliary colic, abnormal liver function tests, and dilated bile duct on US. ERCP was technically successful in all patients. The median fluoroscopy time was 1.45 minutes (range 0-7.2 minutes). There was no perforation, sedation-related adverse event, postsphincterotomy bleeding, cholangitis, or procedure-related maternal or fetal deaths. Post-ERCP pancreatitis was diagnosed in 11 patients (16%). None of these 11 patients had local or systemic complications. Fifty-nine patients had complete follow-up. Endoscopic therapy at the time of ERCP was undertaken in all patients. Furthermore, 9 patients (32.1%) underwent cholecystectomy in the first and second trimesters for either acute cholecystitis (6) or symptomatic gallstones (3). Term pregnancy was achieved in 53 patients (89.8%). Patients having ERCP in the first trimester had the lowest percentage of term pregnancy (73.3%) and the highest risk of preterm delivery (20.0%) and low-birth-weight newborns (21.4%). None of the 59 patients with long-term follow-up had spontaneous fetal loss, perinatal death, stillbirth, or fetal malformation. Limitation: Retrospective review. Conclusions: ERCP can be performed safely during pregnancy. Further, ERCP performed in pregnancy leads to specific therapy in essentially all patients. However, ERCP may be associated with a higher rate of post-ERCP pancreatitis than in the general population. [Copyright &y& Elsevier]

Background: Anticoagulation and antiplatelet medications may potentiate GI bleeding, and their use may lead to an increased need for a GI endoscopy. We hypothesized that there might be different practice patterns among international endoscopists. Objective: To explore the differences in management practices for patients who receive anticoagulation and antiplatelet medications from Eastern and Western endoscopists. Design: International survey study. Setting: Academic medical centers and private clinics. Subjects: Members of the American Society for Gastrointestinal Endoscopy (ASGE) in Eastern (Korea, Japan, China, India, Thailand, Singapore, Malaysia, and Philippines) and Western (United States and Canada) countries were invited to complete a Web-site–based questionnaire. In addition, the questionnaire was sent to university hospitals in South Korea and academic institutions in the United States. Methods: A survey was administered that contained detailed questions about the use of an endoscopy in patients on anticoagulation and antiplatelet medications. Main Outcome Measurements: Different opinions and clinical practice patterns regarding the use of anticoagulation and antiplatelet medications by Eastern and Western endoscopists. Results: A total of 105 Eastern and 106 Western endoscopists completed the survey. Western endoscopists experienced more instances of procedure-related bleeding (P = .003) and thromboembolism after withdrawal of medications (P = .016). Eastern endoscopists restarted medications later (1-3 days) than Western endoscopists after a biopsy (same day) (P < .001). Eastern endoscopists withdrew aspirin for more than 7 days before a polypectomy and then restarted it 1 to 3 days after a polypectomy, whereas Western endoscopists performed a polypectomy without withdrawing aspirin (P < .001). ASGE guidelines were followed less often by Eastern than by Western endoscopists (P < .001). Limitations: Low response rate, heterogeneity of the sample, and recall bias. Conclusions: The opinions and clinical practice patterns for the management of anticoagulation and antiplatelet medications differed significantly between Eastern and Western endoscopists. The lack of uniformity in practice patterns suggests that more data and better education are required in the area of GI endoscopy for patients on anticoagulation and antiplatelet medications, particularly given that individual patient characteristics may be associated with unique types of complications. [Copyright &y& Elsevier]

Background: Lymphangiohemangioma, also called lymphatic-venous or venolymphatic malformation, is a rare malformation of the lymphatics, with vascular elements. These are low-flow vascular lesions. Objective: To evaluate the feasibility and efficacy of endoscopic injection sclerotherapy with doxycycline for low-flow vascular malformations in the GI tract. Design: Case report. Setting: Academic center. Patients: An adult man with lymphangiohemangioma that involved the mediastinum and the esophagus. The esophageal involvement caused dysphagia and chest pain. Interventions: We characterized the lesion with EUS and successfully treated the esophageal and paraesophageal lesions with endoscopic injection sclerotherapy by using doxycycline. Main Outcome Measurement: Symptom resolution and complications. Results: The patient''s esophageal symptoms resolved with sclerotherapy. This is the first reported case of lymphangiohemangioma with esophageal involvement and the first reported case of endoscopic injection sclerotherapy by using doxycycline in the GI tract. Limitations: Case report and short follow-up period. Conclusions: Endoscopic injection sclerotherapy with doxycycline for lymphatic and low-flow vascular malformations in the GI tract is feasible, easy, safe, and effective. [Copyright &y& Elsevier]