Prolonged cholestasis following endoscopic retrograde cholangiopancreatography, a rare complication of contrast agent induced liver injury: A case report and literature review

Abstract

Rationale: Prolonged cholestasis is a rare complication associated with endoscopic retrograde cholangiopancreatography (ERCP).

Patient concerns: A 68-year-old man who presented with worsening cholestasis after ERCP for the removal of a common bile duct stone.

Diagnosis: Total bilirubin increased up to 35.2 mg/dL after the 21st day post-ERCP. A percutaneous liver biopsy was performed and drug-related cholestasis was suspected as occurring as a result of the contrast agent.

Interventions: Oral ursodeoxycholic acid and cholestyramine were prescribed to the patient.

Outcomes: By the 7th week post-ERCP, the patient's symptoms and markers of physiological health began to resolve. The bilirubin returned to normal levels on the 106th day post-ERCP. We reviewed the literature for studies of 9 patients with jaundice more than 30 days post-ERCP, the peak of total serum bilirubin occurred on 16th ± 7th days and the recovery followed after mean time of 54th ± 22th days.

Lessons: Although the cholestasis was prolonged, the outcome was favorable after medical therapy. There were no long-term consequences for the patient.

Figure 1

The clinical course of the patient.

Figure 2

(A) Liver biopsy result showing marked cholestasis with portal and periportal inflammatory cells aggregation (H&E stain, ×200). (B) Portal inflammation consisting of lymphocytes, eosinophils, and neutrophils. No granuloma or plasma cells infiltrate are seen (H&E stain, ×400). H&E = hematoxylin and eosin.