Plasmapheresis and corticosteroid treatment for persistent jaundice after successful drainage of common bile duct stones by endoscopic retrograde cholangiography

doi:10.3748/wjg.v13.i30.4152

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Aug 14, 2007 (publication date) through Dec 22, 2024

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Aug 14, 2007; 13(30): 4152-4153
Published online Aug 14, 2007. doi: 10.3748/wjg.v13.i30.4152

Plasmapheresis and corticosteroid treatment for persistent jaundice after successful drainage of common bile duct stones by endoscopic retrograde cholangiography

Ulku Saritas, Bunyamin Aydin, Yucel Ustundag

Ulku Saritas, Bunyamin Aydin, Gastroneterology Department, Süleyman Demirel University, School of Medicine, Turkey

Yucel Ustundag, Gastroenterology Department, Zonguldak Karaelmas University, School of Medicine, Turkey

Author contributions: All authors contributed equally to the work.

Correspondence to: Yucel Ustundag, Gastroenterology Department, Zonguldak Karaelmas University, School of Medicine, Bagcilar 5. sok 7/4 Ceren Apt Gaziosmanpasa 06100 Ankara, Turkey. yucel_u@yahoo.com

Fax: +90-37-22610169

Received: March 20, 2007
Revised: April 1, 2007
Accepted: April 4, 2007
Published online: August 14, 2007

Abstract

Prolonged cholestasis is a very rare complication of endoscopic retrograde cholangiography (ERC). Only few cases with this complication are reported in the English literature. We report persisting cholestatic jaundice in a 73-year old man after successful therapeutic ERC for choledocholithiasis. Serologic tests for viral and autoimmune hepatitis were all negative. A second-look ERC was normal also. He denied any medication except for prophylaxis given intravenous 1 g ceftriaxon prior to the ERC procedure. After an unsuccessful trial with ursodeoxycholic acid and cholestyramine for 2 wk, this case was efficiently treated with corticosteroids and plasmapheresis. His cholestatic enzymes became normal and intense pruritis quickly resolved after this treatment which lasted during his follow-up period. We discussed the possible mechanisms and treatment alternatives of intrahepatic cholestasis associated with the ERC procedure.

Keywords: Endoscopic retrograde cholangiography; Cholestasis; Plasmapheresis