Combined endoscopic and ursodeoxycholic acid treatment of biliary cast syndrome in a non-transplant patient.
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.
Katsinelos
Panagiotis
P
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.
Kountouras
Jannis
J
Chatzimavroudis
Grigoris
G
Zavos
Christos
C
Pilpilidis
Ioannis
I
Paroutoglou
George
G
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*
D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid
Eur J Gastroenterol Hepatol. 2003 Apr;15(4):415-7
12655263
Gastrointest Endosc. 1993 Jul-Aug;39(4):579-81
8365616
Gut. 1992 Aug;33(8):1123-5
1398240
Clin Liver Dis. 2004 Feb;8(1):67-81, vi
15062194
Am J Gastroenterol. 2003 Aug;98(8):1861-7
12907345
Aliment Pharmacol Ther. 2003 Nov 15;18(10):963-72
14616161
Am J Med. 2000 Apr 15;108(6):481-6
10781781
Hepatogastroenterology. 1988 Feb;35(1):22-4
3283014
Eur J Gastroenterol Hepatol. 2003 Apr;15(4):341-3
12655251
Aliment Pharmacol Ther. 2000 May;14 Suppl 2:54-7
10903005
J Clin Gastroenterol. 2008 Jul;42(6):752-5
18496388
Gut. 1985 Jul;26(7):734-8
3894170
Dig Dis. 1999;17(3):133-44
10697662
Surgery. 1977 Feb;81(2):212-21
319551
Ann Intern Med. 1995 Jun 15;122(12):899-905
7755224
Ann Intern Med. 1982 Sep;97(3):351-6
7051912