Best Practices for Gastrointestinal Endoscopy During Pregnancy

Gastrointestinal (GI) endoscopy, although rarely performed during pregnancy—comprising only about 0.4% of procedures—becomes necessary in certain urgent clinical situations. Recognizing the safety and risks involved, a comprehensive review conducted by physician-scientists from Beth Israel Deaconess Medical Center (BIDMC) and published in the American Journal of Gastroenterology offers valuable guidance for healthcare providers. This review emphasizes a careful, evidence-informed, multidisciplinary approach to ensure maternal and fetal safety when GI endoscopy cannot be postponed.

According to senior author Dr. Tyler M. Berzin, adverse pregnancy outcomes related to GI endoscopy are extremely rare. He highlights the importance of a coordinated approach involving obstetricians, maternal-fetal medicine specialists, anesthesiologists, and gastroenterologists to minimize risks.

Pre-procedural planning involves assessing whether the procedure is urgent or elective. While elective procedures can often be delayed, urgent indications such as gastrointestinal bleeding or bile duct infections demand prompt intervention. It's also crucial to consider contraindications like imminent delivery or pregnancy complications such as eclampsia.

A multidisciplinary team should be engaged early to coordinate care. Anesthesia management in pregnancy requires special attention: short-acting sedatives at low doses are generally safe, but providers must be vigilant about risks like aspiration and apnea.

Procedural considerations focus on minimizing procedure time and risks by utilizing experienced teams. Positioning the patient correctly is vital—after 20 weeks of gestation, the supine position should be avoided to prevent compression of major vessels; the left lateral decubitus or left pelvic tilt positions are recommended. Medication safety is paramount: many commonly used drugs are limited or contraindicated during pregnancy. Agents such as epinephrine are usually avoided but may be used with caution in certain high-risk situations, balancing benefits and risks. NSAIDs should be avoided after 20 weeks due to fetal risks, and fluoroscopy during procedures like ERCP should be minimized to reduce radiation exposure.

Post-procedural care includes vigilant monitoring for complications, with fetal surveillance and obstetric consultation as needed. Early intervention for adverse events is essential.

Dr. Berzin emphasizes that, despite initial concerns, with informed planning and careful execution, GI endoscopy can be safely performed during pregnancy when clinically indicated. A proactive, multidisciplinary approach—integrating gastroenterology, obstetrics, and anesthesia—ensures optimal outcomes for both mother and child.

This guidance aims to support healthcare providers in delivering safe and effective care, reducing anxiety and fostering trust during complex procedures in pregnant patients.

source: https://medicalxpress.com/news/2025-08-gi-endoscopy-pregnancy.html