Endoscopic retrograde cholangiopancreatography (ERCP) is currently one of the most
important tools for diagnosis and treatment of pancreatic and biliary diseases. Propofol
is increasingly used for safe sedation in ERCP [1]
[2]. Despite its demonstrated safety, propofol has been associated with cases of severe
side effects such as pancreatitis [3] or hepatitis [4].
A 66-year-old man diagnosed 2 months previously with biliary pancreatitis with residual
choledocholithiasis, had recently undergone a therapeutic ERCP under brief sedation
with propofol. At 48 hours after ERCP, he was admitted because of an acute condition
with abdominal pain, nausea, vomiting, and increasing liver enzyme levels. Abdominal
ultrasound and computed tomography (CT) showed normal findings. Blood analysis revealed
an increase to 50 times the reference value for aspartate aminotransferase (AST) and
alanine aminotransferase (ALT), with a slight increase in gamma-glutamyltranferase
(GGT) and alkaline phosphatase, and a total bilirubin of 8.9 mg/dl (normal range 0.2–1 mg/dl)
with excess of conjugated bilirubin. Serum amylase was normal. An in-depth investigation
ruled out other causes of acute hepatitis. The patient did not want to undergo liver
biopsy. He was treated with supportive measures, vitamin K, and cholestyramine. In
the 2 months’ follow-up, the patient was asymptomatic and the liver enzymes were normal.
Propofol is a hypnotic agent that has been widely used since its approval in 1989
[3], and is actually the agent of choice in several ambulatory surgical procedures.
It has been as effective as other sedative agents, with lesser side effects [1]
[2], and has been shown to provide a better recovery from anesthesia than other drugs
[1]. The main side effect of propofol is hypotension [1]
[2], but other more important side effects have been reported, such as pancreatitis
[3], transient desaturation and apnea [2], and acute hepatitis [4]. Liver injury secondary to the use of propofol has been associated with long-term
infusion of the drug, rhabdomyolysis, acidemia and bradyarrythmias [4]. The pathophysiology of propofol-induced hepatitis remains unclear. Some authors
point to a immunologic mechanism as the cause of liver injury associated with the
use of another sedative agent, pethidine [5]. In spite of these side effects, we consider that propofol remains the drug of choice
for brief sedation in ERCP.
Endoscopy_UCTN_Code_CPL_1AK_2AC
Endoscopy_UCTN_Code_CPL_1AK_2AJ
