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 35.2mg/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.