Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2023; 29(14): 2127-2133
Published online Apr 14, 2023. doi: 10.3748/wjg.v29.i14.2127
COVID-19 related biliary injury: A review of recent literature
Sujani Yadlapati, Simone A. Jarrett, Daniel Baik, Adib Chaaya
Sujani Yadlapati, Daniel Baik, Adib Chaaya, Department of Gastroenterology, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ 08103, United States
Simone A. Jarrett, Department of Internal Medicine, Einstein Medical Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19140, United States
Author contributions: Yadlapati S contributed to conceptualization, original draft preparation, and final revisions; Jarrett SA contributed to original draft preparation; Baik D contributed to final revisions; Chaaya A contributed to conceptualization and final revisions.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Sujani Yadlapati, MD, Department of Gastroenterology, Cooper University Hospital, Cooper Medical School of Rowan University, 1 Cooper Plaza, Camden, NJ 08103, United States.
Received: November 19, 2022
Peer-review started: November 19, 2022
First decision: February 23, 2023
Revised: March 11, 2023
Accepted: March 21, 2023
Article in press: March 21, 2023
Published online: April 14, 2023

Since its emergence in 2019, it has become apparent that coronavirus 2019 (COVID-19) infection can result in multi systemic involvement. In addition to pulmonary symptoms, hepatobiliary involvement has been widely reported. Extent of hepatic involvement ranges from minor elevation in liver function tests (LFTs) to significant hepatocellular or cholestatic injury. In majority of cases, resolution of hepatic injury or improvement in LFTs is noted as patients recover from COVID-19 infection. However, severe biliary tract injury progressing to liver failure has been reported in patients requiring prolonged intensive care unit stay or mechanical ventilation. Due to the timing of its presentation, this form of progressive cholestatic injury has been referred to as COVID-19 cholangiopathy or post-COVID-19 cholangiopathy, and can result in devastating consequences for patients. COVID-19 cholangiopathy is recognized by dramatic elevation in serum alkaline phosphatase and bilirubin and radiologic evidence of bile duct injury. Cholangiopathy in COVID-19 occurs weeks to months after the initial infection and during the recovery phase. Imaging findings and pathology often resemble bile duct injury associated with primary or secondary sclerosing cholangitis. Etiology of COVID-19 cholangiopathy is unclear. Several mechanisms have been proposed, including direct cholangiocyte injury, vascular compromise, and cytokine release syndromes. This review summarizes existing data on COVID-19 cholangiopathy, including reported cases in the literature, proposed pathophysiology, diagnostic testing, and long-term implications.

Keywords: COVID-19 cholangiopathy, Post COVID-19 cholangiopathy, Cholestatic injury, Liver transplant

Core Tip: Severe cholangiopathy can develop in critically ill coronavirus 2019 patients during recovery, which is reflected by significant derangements in liver function tests and imaging findings consistent with bile duct injury. This condition may progress to acute liver failure, necessitating liver transplantation, and has emerged as a novel indication for transplantation during the pandemic. There are still uncertainties regarding the long-term survival and clinical outcomes of patients who experience incomplete recovery.