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P230. Endoscopy in IBD women is safe in each trimester of pregnancy

A. de Lima1, Z. Zelinkova1,2, C. van der Ent1, C.J. van der Woude1, 1Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands, 2University Hospital, 5th Department of Internal Medicine, Gastroenterology Unit, Bratislava, Slovakia

Background

Inflammatory bowel disease (IBD) females have a higher risk of undergoing gastro intestinal (GI) endoscopy during pregnancy than healthy females. Although considered generally safe, data on endoscopic procedures during pregnancy in IBD females is limited. Current ASGE guidelines state endoscopic procedures should preferably be performed in the 2nd trimester. The aim of this study is to investigate the safety of lower GI endoscopy during the 3 trimesters in IBD females.

Methods

Out of a prospective cohort of 210 pregnant IBD patients (pts), all pts who underwent endoscopy (cases) during pregnancy were selected. These cases were matched 1:1 with pregnant IBD pts without endoscopy during pregnancy (controls) on maternal age, diagnosis and type of IBD maintenance medication. Maternal and neonatal outcomes were compared between the cases and controls.

Results

In total, 32 pregnant IBD pts (17 CD, 13 UC, 2 IBDU) underwent 36 endoscopies (12 colonoscopies/24 sigmoidoscopies). These endoscopies were equally distributed among the different trimesters (10 in 1st, 14 in 2nd and 12 in 3rd trimester). Endoscopies were diagnostic in 34 cases and therapeutic in 2 cases. The indication for both therapeutic endoscopies was treatment of bowel obstruction. No sedation was used in 14, midazolam in 3, fentanyl in 8, midazolam and fentanyl in 7 and in 4 pts the sedation type was undocumented. Median maternal age was 29 years (IQR: 28–32). Adverse maternal outcomes in the study group included gestational diabetes (n = 2), cholestasis (n = 2), hypertension (n = 1), pancreatitis (n = 1), uncomplicated urinary tract infection (n = 1) and auto-immune hepatitis (n = 1) and in the control group gestational diabetes (n = 1) and large loop excision for cervical intraepithelial neoplasia (n = 1). There was no temporal relationship between the procedures and these outcomes. With respect to neonatal outcome: there were no significant differences between cases and controls in number of miscarriages, birth weight, gestational term, congenital abnormalities and APGAR scores.

Conclusion

Although GI endoscopy during pregnancy should only be performed when strongly indicated, colonoscopy and sigmoidoscopy in all three trimesters of pregnancy have no adverse outcomes for the mother or the newborn.