Unilateral Biportal Endoscopy (UBE): What It Is and What It’s Used For
Patient Guide · Silo Endoscopy · Pregnancy
Is endoscopy safe during pregnancy? When it is performed and how it is adapted
Endoscopy in pregnant women is performed when the benefits outweigh the risks — with tailored sedation and modified technique, it is safe in the second trimester. Complete guide on when it is indicated and how it is managed in Colombia 2026
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Medical team from GSMED Imaging — endoscopy in special situations
Based on: ASGE Guideline on GI endoscopy in pregnancy 2024, ESGE Position Statement on Endoscopy in Pregnancy 2023, Cappell MS (Gastroenterology Clinics — endoscopy in pregnancy 2023) and gastroenterology practice in obstetrics Colombia.
A pregnant woman with active gastrointestinal bleeding, severe colitis, or suspected pathology requiring urgent diagnosis faces a difficult question: is it safe to have an endoscopy with the baby? The answer — based on the ASGE 2024 and ESGE 2023 guidelines — is that endoscopy is safe when properly indicated, adapted to the trimester, and performed by an experienced team. What is not safe is not treating a serious condition due to unfounded fear of the procedure.
1. When is endoscopy indicated during pregnancy?
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Urgent indications — cannot wait
Active upper gastrointestinal bleeding (hematemesis or melena with hemodynamic instability) — urgent endoscopy is indicated regardless of the trimester · Severe colitis with suspected toxic megacolon or fulminant colitis — diagnostic sigmoidoscopy · Acute cholangitis due to choledocholithiasis — urgent ERCP for biliary drainage, with fetal protection using a lead apron and minimizing fluoroscopy.
→ Active bleeding · Severe colitis · Cholangitis — do not wait until delivery
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Elective indications — defer if possible
If the procedure can wait without risk to the mother, it is preferable to defer it until after delivery — especially in the first trimester (higher risk of drug-induced teratogenicity) and late third trimester (risk of preterm birth due to positioning). If it cannot wait, the second trimester (14–28 weeks) is the safest time for elective endoscopy in pregnant women.
→ Defer if it can wait · Second trimester = safest
2. Technical adaptations in endoscopy for pregnant women
| Aspect | Non-pregnant patient | Pregnant woman — adaptation |
|---|---|---|
| Position | Standard left lateral decubitus | Left lateral decubitus with a wedge under the right hip (after 20 weeks) — avoid compression of the inferior vena cava by the uterus |
| Sedation | Midazolam + fentanyl or propofol | Propofol (Category B — safest) + minimal dose of fentanyl · Avoid meperidine (Category C) · No benzodiazepines in the first trimester |
| Fetal monitoring | Not applicable | FHR (fetal heart rate) monitoring before and after the procedure · Tocometry if >24 weeks · Obstetrician available |
| Procedure duration | No restriction | Minimize duration — complete the minimum necessary diagnostic objective · Do not perform additional elective procedures |
| Endoscope position | Standard | Colonoscopy: only up to the splenic angle if possible — the uterus displaces the colon and makes advancement difficult in the third trimester |
3. Real risks of endoscopy during pregnancy
- Maternal hypoxia: sedation can reduce the mother's oxygen saturation — which is transmitted to the fetus. It is prevented with continuous SpO₂ monitoring and administration of supplemental O₂ during the procedure.
- Supine hypotension: in advanced pregnancy, the supine position compresses the vena cava — left lateral decubitus with a wedge prevents it.
- Preterm birth: theoretical risk due to procedure stress — minimized with proper sedation and a short procedure. There is no evidence of a significant increase in prematurity with well-indicated and technically correct endoscopy.
- Drug teratogenicity: the risk is higher in the first trimester. Propofol (FDA Category B) is the agent of choice. Avoid benzodiazepines in the first trimester.
Does endoscopy in pregnant women affect the baby?
Available evidence — including a systematic review of more than 8,000 endoscopies in pregnant women published in 2022 — does not show a significant increase in congenital malformations, spontaneous abortion, or fetal death when endoscopy is performed with an appropriate indication, in the second trimester, and with proper sedation. The main risks are not teratogenic but physiological (hypoxia, hypotension) and are prevented with proper monitoring. The greatest risk to the baby is not endoscopy — it is not treating the mother when the indication is urgent.
Endoscopes for special procedures — GSMED Colombia
Olympus, Fujifilm, and Pentax with technical support for endoscopy units in university and high-complexity hospitals.
