Early detection of COVID-19 cholangiopathy using cholangioscopy—a case report of two critically ill patients

• Published in: European surgery Vol. 54; no. 6; pp. 326 - 330
• Main Authors: Kroepfl, Veronika, Treml, Benedikt, Freund, Martin Cornelius, Profanter, Christoph
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01-12-2022
• Subjects: Abdominal Surgery; Cardiac Surgery; Case Report; General Surgery; Medicine; Medicine & Public Health; Surgery; Vascular Surgery; COVID-19 associated cholangiopathy; Hepathopathy; COVID-19 gastrointestinal manifestations; Intensive-care related complications; Secondary sclerosing cholangitis
• ISSN: 1682-8631; 1682-4016
• DOI: 10.1007/s10353-022-00776-6

Summary
Background
The coronavirus disease 2019 (COVID-19) crisis caused by the severe respiratory distress syndrome coronavirus 2 (SARS-CoV-2) rapidly led to a pandemic. While the majority of SARS-CoV-2-infected patients present with fever and respiratory symptoms, gastrointestinal symptoms may also occur. In addition, serious hepatic manifestations like cholangiopathy and liver failure have been described.
Patients and methods
We identified two critically ill patients suffering from SARS-CoV‑2 infection in our intensive care unit (ICU). In both patients, laboratory testing revealed elevated liver chemistries weeks after initial diagnosis with COVID-19.
Results
During repeated endoscopic retrograde cholangiopancreatography (ERCP) with cholangioscopy, a severely destructed biliary mucosa with ischemia and epithelial roughness was seen in both patients. Due to the prolonged course of COVID-19 and chronic liver damage with ongoing sepsis, both patients succumbed to the disease.
Conclusion
In our opinion, a COVID-19 infection can lead to development of cholangiopathy in critically ill patients. Cholangioscopy performed early can confirm the diagnosis of COVID-19-associated cholangioscopy.