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

World J Gastroenterol. 2007 Aug 14;13(30):4152-3. doi: 10.3748/wjg.v13.i30.4152.

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 ceftriaxone 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 pruritus 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.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Aged
  • Cholangiopancreatography, Endoscopic Retrograde / adverse effects*
  • Choledocholithiasis / complications
  • Choledocholithiasis / therapy*
  • Drainage / methods
  • Humans
  • Jaundice, Obstructive / etiology*
  • Jaundice, Obstructive / therapy*
  • Male
  • Plasmapheresis / methods*

Substances

  • Adrenal Cortex Hormones