Biliary acute pancreatitis (AP) in pregnancy poses unique management challenges, and current guidelines in pancreatology, obstetrics, and surgery lack specific recommendations. This study evaluated the safety and effectiveness of cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) performed during pregnancy.

This international retrospective multicenter cohort study collected data on demographics, clinical presentation, management strategies, timing and type of cholecystectomy, procedural approaches, complications, and outcomes. Continuous variables were reported as medians with interquartile ranges, while categorical variables were presented as frequencies and percentages. Group comparisons were performed using Welch’s t-test, Pearson’s chi-squared test, or Fisher’s exact test.

A total of 101 cases from 14 countries and 19 centers were included. Following mild AP during pregnancy, cholecystectomy was associated with a lower readmission rate due to recurrent AP or other gallstone-related complications compared with conservative management (0% vs 24%; n=0/17 vs n=12/49; p=0.027). Cholecystectomy during pregnancy had a low complication rate, comparable to postpartum surgery (12% vs 10%; n=2/17 vs n=3/30; p>0.999). Preterm birth occurred in 7.1% (n=1/14) of patients who underwent cholecystectomy versus 11% (n=5/45) without surgery. Fetal loss after surgery was observed only during the first trimester (n=3/17 vs n=1/49).Regarding ERCP, no significant differences were observed between the surgical and ERCP groups in rates of readmission (5%, n=1/21 vs 27%, n=4/15; p=0.138), fetal loss (5%, n=1/21 vs 27%, n=4/15; p=0.138), or preterm birth (6%, n=1/17 vs 8%, n=1/12; p>0.999). Likewise, among patients who underwent ERCP versus those who did not, fetal loss (9.1%, n=2/22 vs 5.4%, n=4/74; p=0.618) and preterm birth rates (5.9%, n=1/17 vs 12%, n=8/65; p=0.677) did not differ significantly. 

Cholecystectomy is safe and effective in the second and third trimesters after a mild biliary pancreatitis during pregnancy, while ERCP can be safely performed in any trimester.