title: Combined endoscopic and ursodeoxycholic acid treatment of biliary cast syndrome in a non-transplant patient.
abstract: A 76-year-old diabetic man underwent cholecystectomy for gangrenous calculous cholecystitis. His postoperative course was complicated by the development of Candida albicans esophagitis necessitating antifungal therapy, and total parenteral nutrition (TPN) for 15 d. Seven weeks after cholecystectomy, he presented with cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated extrahepatic filling defects. Despite endoscopic extraction of a biliary cast, cholestasis remained unchanged. Oral administration of ursodeoxycholic acid (UDCA), 750 mg/d, resulted in normalization of liver function tests. We, therefore, propose for the first time, combined endoscopic plus UDCA treatment for the management of biliary cast syndrome.
authors.affiliation: Department of Endoscopy and Motility Unit, Central Hospital, and Department of Gastroenterology, Second Medical Clinic, Aristotle University of Thessaloniki, Ethnikis Aminis 41, Thessaloniki 54635, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Katsinelos
authors.forename: Jannis
authors.initials: J
authors.lastname: Kountouras
authors.forename: Grigoris
authors.initials: G
authors.lastname: Chatzimavroudis
authors.forename: Christos
authors.initials: C
authors.lastname: Zavos
authors.forename: Ioannis
authors.initials: I
authors.lastname: Pilpilidis
authors.forename: George
authors.initials: G
authors.lastname: Paroutoglou
mesh_terms: D000368:Aged; D002756:Cholagogues and Choleretics / Q000627:therapeutic use*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000188:drug therapy* / Q000601:surgery*; D002763:Cholecystectomy; D002764:Cholecystitis / Q000601:surgery; D002780:Cholestasis, Intrahepatic / Q000188:drug therapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use*
chemical_list: D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid
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