Endoscopic Features of Post-COVID-19 Cholangiopathy and Its Management Using ERCP.
Journal
The American journal of gastroenterology
ISSN: 1572-0241
Titre abrégé: Am J Gastroenterol
Pays: United States
ID NLM: 0421030
Informations de publication
Date de publication:
01 Dec 2023
01 Dec 2023
Historique:
received:
11
06
2023
accepted:
22
09
2023
pubmed:
16
10
2023
medline:
16
10
2023
entrez:
16
10
2023
Statut:
aheadofprint
Résumé
Despite growing awareness of post-coronavirus disease 2019 (COVID-19) cholangiopathy as one of the most serious long-term gastrointestinal consequences of COVID-19, the endoscopic features of this disease are still poorly characterized. This study aimed to more precisely define its endoscopic features and to outline the role of endoscopic retrograde cholangiopancreatography (ERCP) in the management of this entity. In this observational study, 46 patients with confirmed post-COVID-19 cholangiopathy were included. Based on the endoscopic features observed in 141 ERCP procedures, post-COVID-19 cholangiopathy can be classified as a variant of secondary sclerosing cholangitis in critically ill patients. It appeared early in the course of intensive care treatment of patients with COVID-19 (cholestasis onset 4.5 days after intubation, median). This form of cholangiopathy was more destructive than stricturing in nature and caused irreversible damage to the bile ducts. A centripetal pattern of intrahepatic bile duct destruction, the phenomenon of vanishing bile ducts, the absence of extrahepatic involvement, and the presence of intraductal biliary casts (85% of patients) were typical cholangiographic features of post-COVID-19 cholangiopathy. This cholangiopathy was often complicated by small peribiliary liver abscesses with isolation of Enterococcus faecium and Candida spp. in bile culture. The prognosis was dismal, with a 1-year liver transplantation-free survival rate of 44%. In particular, patients with peribiliary liver abscesses or destruction of the central bile ducts tended to have a poor prognosis (n.s.). As shown by multivariate analysis, bilirubin levels (on intensive care unit day 25-36) negatively correlated with liver transplantation-free survival (hazard ratio 1.08, P < 0.001). Interventional endoscopy with cast removal had a positive effect on cholestasis parameters (gamma-glutamyl transpeptidase, alkaline phosphatase, and bilirubin); approximately 60% of all individual values decreased. Gastrointestinal endoscopy makes an important contribution to the management of post-COVID-19 cholangiopathy. ERCP is not only of great diagnostic and prognostic value but also has therapeutic value and therefore remains indispensable.
Identifiants
pubmed: 37843039
doi: 10.14309/ajg.0000000000002562
pii: 00000434-990000000-00919
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.
Références
Edwards K, Allison M, Ghuman S. Secondary sclerosing cholangitis in critically ill patients: A rare disease precipitated by severe SARS-CoV-2 infection. BMJ Case Rep 2020;13(11):e237984.
Roth NC, Kim A, Vitkovski T, et al. Post-COVID-19 cholangiopathy: A novel entity. Am J Gastroenterol 2021;116(5):1077–82.
Durazo FA, Nicholas AA, Mahaffey JJ, et al. Post-Covid-19 cholangiopathy-A new indication for liver transplantation: A case report. Transpl Proc 2021;53(4):1132–7.
Keta-Cov research group Electronic address vincentmallet@aphpfr. Intravenous ketamine and progressive cholangiopathy in COVID-19 patients. J Hepatol 2021;74(5):1243–4.
Butikofer S, Lenggenhager D, Wendel Garcia PD, et al. Secondary sclerosing cholangitis as cause of persistent jaundice in patients with severe COVID-19. Liver Int 2021;41(10):2404–17.
Klindt C, Jensen BE, Brandenburger T, et al. Secondary sclerosing cholangitis as a complication of severe COVID-19: A case report and review of the literature. Clin Case Rep 2021;9(5):e04068.
de Tymowski C, Depret F, Dudoignon E, et al. Ketamine-induced cholangiopathy in ARDS patients. Intensive Care Med 2021;47(10):1173–4.
Faruqui S, Okoli FC, Olsen SK, et al. Cholangiopathy after severe COVID-19: Clinical features and prognostic implications. Am J Gastroenterol 2021;116(7):1414–25.
Leonhardt S, Jürgensen C, Frohme J, et al. Hepatobiliary long-term consequences of COVID-19: Dramatically increased rate of secondary sclerosing cholangitis in critically ill COVID-19 patients. Hepatol Int 2023;17(6):1610–25.
Hunyady P, Streller L, Ruther DF, et al. Secondary sclerosing cholangitis following coronavirus disease 2019 (COVID-19): A multicenter retrospective study. Clin Infect Dis 2023;76(3):e179–87.
Kirchner GI, Rummele P. Update on sclerosing cholangitis in critically ill patients. Viszeralmedizin 2015;31(3):178–84.
Kurth F, Roennefarth M, Thibeault C, et al. Studying the pathophysiology of coronavirus disease 2019: A protocol for the Berlin prospective COVID-19 patient cohort (Pa-COVID-19). Infection 2020;48(4):619–26.
Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: An attempt at consensus. Gastrointest Endosc 1991;37(3):383–93.
European Association for the Study of the Liver. EASL clinical practice guidelines: Management of cholestatic liver diseases. J Hepatol 2009;51(2):237–67.
Buis CI, Verdonk RC, Van der Jagt EJ, et al. Nonanastomotic biliary strictures after liver transplantation, part 1: Radiological features and risk factors for early vs. late presentation. Liver Transpl 2007;13(5):708–18.
Rossi G, Sciveres M, Maruzzelli L, et al. Diagnosis of sclerosing cholangitis in children: Blinded, comparative study of magnetic resonance versus endoscopic cholangiography. Clin Res Hepatol Gastroenterol 2013;37(6):596–601.
Leonhardt S, Veltzke-Schlieker W, Adler A, et al. Secondary sclerosing cholangitis in critically ill patients: Clinical presentation, cholangiographic features, natural history, and outcome: A series of 16 cases. Medicine (Baltimore) 2015;94(49):e2188.
Ruiz A, Lemoinne S, Carrat F, et al. Radiologic course of primary sclerosing cholangitis: Assessment by three-dimensional magnetic resonance cholangiography and predictive features of progression. Hepatology 2014;59(1):242–50.
Waldram R, Williams R, Calne RY. Bile composition and bile cast formation after transplantation of the liver in man. Transplantation 1975;19(5):382–7.
Gor NV, Levy RM, Ahn J, et al. Biliary cast syndrome following liver transplantation: Predictive factors and clinical outcomes. Liver Transpl 2008;14(10):1466–72.
Zhu XD, Shen ZY, Chen XG, et al. Pathotyping and clinical manifestations of biliary cast syndrome in patients after an orthotopic liver transplant. Exp Clin Transpl 2013;11(2):142–9.
Yang YL, Zhang C, Lin MJ, et al. Biliary casts after liver transplantation: Morphology and biochemical analysis. World J Gastroenterol 2013;19(43):7772–7.
Ghafoor S, Germann M, Jungst C, et al. Imaging features of COVID-19-associated secondary sclerosing cholangitis on magnetic resonance cholangiopancreatography: A retrospective analysis. Insights Imaging 2022;13(1):128.
Santos-Rosa OM, Lunardelli HS, Ribeiro-Junior MA. Pyogenic liver abscess: Diagnostic and therapeutic management. Arq Bras Cir Dig 2016;29(3):194–7.
Ozgul E. Multiple pyogenic liver abscesses mimicking metastatic disease on computed tomography. Cureus 2020;12(2):e7050.
Kong H, Yu F, Zhang W, et al. Clinical and microbiological characteristics of pyogenic liver abscess in a tertiary hospital in East China. Medicine (Baltimore) 2017;96(37):e8050.
Luo M, Yang XX, Tan B, et al. Distribution of common pathogens in patients with pyogenic liver abscess in China: A meta-analysis. Eur J Clin Microbiol Infect Dis 2016;35(10):1557–65.
Meddings L, Myers RP, Hubbard J, et al. A population-based study of pyogenic liver abscesses in the United States: Incidence, mortality, and temporal trends. Am J Gastroenterol 2010;105(1):117–24.
Losie JA, Lam JC, Gregson DB, et al. Epidemiology and risk factors for pyogenic liver abscess in the calgary health zone revisited: A population-based study. BMC Infect Dis 2021;21(1):939.
Zimmermann L, Wendt S, Lubbert C, et al. Epidemiology of pyogenic liver abscesses in Germany: Analysis of incidence, risk factors and mortality rate based on routine data from statutory health insurance. United Eur Gastroenterol J 2021;9:1039–47.
Chen SC, Yen CH, Lai KC, et al. Pyogenic liver abscesses with Escherichia coli: Etiology, clinical course, outcome, and prognostic factors. Wien Klin Wochenschr 2005;117(23-24):809–15.
Kirstein MM, Book T, Manns MP, et al. Secondary sclerosing cholangitis in critically ill patients has a poor outcome but lower tumour incidence than primary sclerosing cholangitis. United Eur Gastroenterol J 2020;8(6):716–24.
Jaeger C, Mayer G, Henrich R, et al. Secondary sclerosing cholangitis after long-term treatment in an intensive care unit: Clinical presentation, endoscopic findings, treatment, and follow-up. Endoscopy 2006;38(7):730–4.
Bölter L, Zuber-Jerger I, Dobsch P, et al. Endoskopische Dilatationstherapie verlängert das transplantat-freie Überleben von Patient:innen mit sekundär sklerosierender Cholangitis (SSC-CIP). Z Gastroenterol 2022;60(08):e592.
Horvatits T, Drolz A, Trauner M, et al. Liver injury and failure in critical illness. Hepatology 2019;70(6):2204–15.
Fuhrmann V, Kneidinger N, Herkner H, et al. Impact of hypoxic hepatitis on mortality in the intensive care unit. Intensive Care Med 2011;37(8):1302–10.
Kwo PY, Cohen SM, Lim JK. ACG clinical guideline: Evaluation of abnormal liver chemistries. Am J Gastroenterol 2017;112(1):18–35.
Ferreira LE, Baron TH. Post-sphincterotomy bleeding: Who, what, when, and how. Am J Gastroenterol 2007;102(12):2850–8.
Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996;335(13):909–18.
Buechter M, Katsounas A, Saner F, et al. ERCP in critically ill patients is safe and does not increase mortality. Medicine (Baltimore) 2022;101(5):e28606.
Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP: A prospective multicenter study. Gastrointest Endosc 1998;48:1–10.
Singh B, Mechineni A, Kaur P, et al. COVID-19 and bleeding at unusual locations: Report of four cases. Hematol Transfus Cel Ther 2021;43(2):214–8.
Schwarz S, Lang C, Harlander M, et al. Gamma-glutamyltransferase is a strong predictor of secondary sclerosing cholangitis after lung transplantation for COVID-19 ARDS. J Heart Lung Transpl 2022;41(10):1501–10.