title: Plasmapheresis and corticosteroid treatment for persistent jaundice after successful drainage of common bile duct stones by endoscopic retrograde cholangiography.
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.
authors: Gastroneterology Department, Süleyman Demirel University, School of Medicine, Turkey.
authors: Ulku
authors: U
authors: Saritas
authors: Bunyamin
authors: B
authors: Aydin
authors: Yucel
authors: Y
authors: Ustundag
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D042883:Choledocholithiasis / Q000150:complications / Q000628:therapy*; D004322:Drainage / Q000379:methods; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology* / Q000628:therapy*; D008297:Male; D010956:Plasmapheresis / Q000379:methods*
chemical_list: D000305:Adrenal Cortex Hormones
references: Gastrointest Endosc Clin N Am. 2003 Oct;13(4):775-98, xi
references: 14986798
references: Gastrointest Endosc. 1990 Jul-Aug;36(4):426-7
references: 2210304
references: Am J Gastroenterol. 1992 Jul;87(7):886-8
references: 1524599
references: Hepatogastroenterology. 1997 May-Jun;44(15):677-80
references: 9222670
references: Endoscopy. 1997 May;29(4):288-97
references: 9255535
references: Gastrointest Endosc. 1990 Jul-Aug;36(4):425-6
references: 2210303
references: Am J Obstet Gynecol. 2005 Jun;192(6):2088-9
references: 15970907
references: Am J Gastroenterol. 1995 Mar;90(3):518-9
references: 7872305
references: Gastrointest Endosc. 1991 Nov-Dec;37(6):632-3
references: 1756925
references: J Clin Gastroenterol. 1986 Jun;8(3 Pt 1):301-3
references: 3734365
references: Am J Gastroenterol. 2006 Jan;101(1):204-5
references: 16405561
references: Am J Gastroenterol. 1995 May;90(5):828-9
references: 7733099