Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2023; 15(5): 788-798
Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.788
Post-COVID-19 cholangiopathy: Current understanding and management options
Fadl H Veerankutty, Kushan Sengupta, Mukul Vij, Ashwin Rammohan, Dinesh Jothimani, Ananthavadivelu Murali, Mohamed Rela
Fadl H Veerankutty, Institute of Liver Disease and Transplantation, Dr. Rela Institute and Research Centre, Chennai 600044, India
Kushan Sengupta, Ashwin Rammohan, Dinesh Jothimani, Mohamed Rela, Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai 600044, India
Mukul Vij, Department of Pathology, Institute of Liver Disease and Transplantation, Chennai 600044, India
Ananthavadivelu Murali, Gastroenterology and Hepatology, Clinician’s Point, Chennai 600014, Tamil Nadu, India
Author contributions: Veerankutty FH conceptualized the study; Veerankutty FH, Sengupta K, and Vij M collected the data and contributed to manuscript preparation; Veerankutty FH, Ashwin Rammohan, Jothimani D, Murali A and Rela M drafted and edited the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Fadl H Veerankutty, MBBS, MS, FMAS, DrNB (Gastrointestinal Surgery), Post-Doctoral Fellowship in Liver Transplant & HPB Surgery, Consultant Physician-Scientist, Surgeon, Institute of Liver Disease and Transplantation, Dr. Rela Institute and Research Centre, 7, CLC Works Rd, Nagappa Nagar, Chromepet, Chennai 600044, India.
Received: November 23, 2022
Peer-review started: November 23, 2022
First decision: January 2, 2023
Revised: February 10, 2023
Accepted: April 7, 2023
Article in press: April 7, 2023
Published online: May 27, 2023

Post-coronavirus disease 2019 (COVID-19) cholangiopathy (PCC) is a rare but life-threatening complication of COVID-19 infection. PCC typically presents when patients recovering from the contagion and manifests as cholestasis in patients with no history of pre-existing liver disease. The pathogenesis of PCC is little understood. Hepatic injury in PCC could be mediated by the predilection of severe acute respiratory syndrome coronavirus 2 for cholangiocytes. Though PCC shows some resemblance to secondary sclerosing cholangitis in critically ill patients, it is considered as a separate and unique entity in the literature. Various treatment options like ursodeoxycholic acid, steroids, plasmapheresis, and endoscopic retrograde cholangiopancreatography guided interventions have been tried but with limited success. We have noticed significant improvement in liver function with antiplatelet therapy in a couple of patients. PCC can progress to end-stage liver disease necessitating liver transplantation. In this article, we discuss the current knowledge of PCC focusing on its pathophysiology, clinical manifestations, and management strategies.

Keywords: COVID-19, Liver, Post-COVID-19 syndrome, Long haulers, Cholangiopathy, Cholestasis

Core Tip: Post-coronavirus disease 2019 (COVID-19) cholangiopathy (PCC) is a rare complication of COVID-19 infection with gruesome prognosis. There is no proven treatment for this entity and patients often end up in liver transplantation. This review focusses on pathophysiology, clinical manifestations and management strategies of PCC along with our experience with antiplatelets in managing patients with PCC.