Biliary Tract Injury in Patients With COVID-19: A Review of the Current Literature

Abstract

Multiple studies and extensive clinical experience have shown that COVID-19 can impact the hepatobiliary system, with most reports describing primarily hepatocellular injury with elevations of aspartate aminotransferase and alanine aminotransferase. In addition to hepatocellular injury, recent literature has described a pattern of severe biliary tract injury resulting in patients with COVID-19. This novel syndrome, termed COVID-19 cholangiopathy, may have severe consequences for affected patients. This article will examine the literature describing this novel entity, its relationship to secondary sclerosing cholangitis, clinical outcomes, and proposed mechanisms underlying this form of biliary injury.

Keywords: COVID-19; bile duct injury; cholangiopathy; liver; sclerosing cholangitis.

Figure 1.

Coronal magnetic resonance cholangiopancreatography image of a 60-year-old man demonstrating multifocal mild diffuse intrahepatic biliary dilatation with beaded appearance.

Figure 2.

Axial contrast-enhanced T1-weighted magnetic resonance image (A) and diffusion-weighted image (B) demonstrating peribiliary enhancement and diffusion restriction (arrows) compatible with active inflammation.

Figure 3.

Coronal endoscopic retrograde cholangiopancreatography image demonstrating multifocal intrahepatic biliary dilation with stricturing, predominantly involving the left lobe.