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Endoscopy 2006; 38(7): 730-734
DOI: 10.1055/s-2006-925241
Short Communication
© Georg Thieme Verlag KG Stuttgart · New York

Secondary sclerosing cholangitis after long-term treatment in an Intensive care unit: clinical presentation, endoscopic findings, treatment, and follow-up

C.  Jaeger1, 2 , G.  Mayer1 , R.  Henrich1 , L.  Gossner1 , T.  Rabenstein1 , A.  May1 , E.  Guenter1 , C.  Ell1
  • 1 Department of Medicine II, HSK Wiesbaden (Teaching Hospital of the University of Mainz), Wiesbaden, Germany
  • 2 Third Medical Department and Policlinic, Giessen, University of Giessen and Marburg, Germany
Further Information

Publication History

Submitted 28 October 2005

Accepted after revision 22 January 2006

Publication Date:
11 May 2006 (online)

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Background and Study Aims: We present ten patients who developed secondary sclerosing cholangitis following long-term treatment in an intensive care unit (ICU) between 1999 and 2004.
Patients and Methods: Ten consecutive patients who had no evidence suggestive of pre-existing hepatobiliary disease were admitted to an ICU because of trauma (n = 5), intracerebral hemorrhage (n = 3), or nonabdominal postsurgical complications (n = 2). All the patients had required treatment with long-term ventilation, catecholamines, total parenteral nutrition, and several antimicrobial agents.
Results: Cholestasis was first noted within 11 days after the initial insult. Endoscopic retrograde cholangiopancreatography (ERCP), performed after a median follow-up of 69 days, revealed multifocal stricturing and beading of the intrahepatic bile ducts, and attenuation of the peripheral branches. In all the patients, the bile ducts were partially filled by black-pigmented thrombotic material. All the patients underwent endotherapy, which comprised sphincterotomy and removal of the occluding material, in an attempt to improve biliary drainage; the treatment had to be repeated in seven of the ten patients. After a median follow-up period of 21 months, despite transient clinical improvement following endotherapy, complete recovery has not been achieved in any of the patients and so far one patient has had to undergo orthotopic liver transplantation as a result of end-stage liver disease.
Conclusions: The development of secondary sclerosing cholangitis in patients who have received long-term treatment in an ICU is a rare event of unknown pathophysiology, but patients demonstrate characteristic findings on ERCP. It is not known whether endotherapy can delay the progress of the condition in the long term.

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C. Jaeger, M. D.

Third Medical Department and Policlinic · University of Giessen and Marburg

Rodthohl 6 · 35385 Giessen · Germany

Fax: +49-641-99-42759

Email: clemens.jaeger@innere.med.uni-giessen.de