A new combined treatment of biliary cast syndrome

Biliary cast syndrome is a syndrome which is characterised by the presence of casts causing obstruction of the biliary tree, thus leading to biliary infection, hepatocyte damage secondary to bile stasis and ductal damage, all contributing to cholangiopathy. The development of total biliary cast is very uncommon, especially in non-transplant patients. The etiology of biliary cast formation in these cases is uncertain but several factors are believed to play a role, including periods of fasting, hemolysis, cholangitis and recent surgery. Resultant bile stasis and/or gallbladder hypocontractility promote sludge and subsequent stone formation.

A case report article article to be published on September 7, 2008 in the World Journal of Gastroenterology describes the beneficial effect of a combined therapy in the treatment of a biliary cast syndrome. More specifically, the endoscopic team, led by Dr. Katsinelos from the Endoscopy and Motility Unit of Central Hospital of Thessaloniki, Greece studied the combined treatment of endoscopic and ursodeoxycholic acid treatment of a biliary cast syndrome in a non-transplant patient. A 76-year-old diabetic man underwent cholecystectomy for gangrenous calculus cholecystitis. His postoperative course was complicated by the development of Candida albicans esophagitis, necessitating antifungal therapy and total parenteral nutrition for 15 d. Seven weeks after cholecystectomy he presented with cholangitis and endoscopic retrograde cholangiopancreatography (ERCP) demonstrated extrahepatic filling defects. Despite endoscopic extraction of a biliary cast, cholestasis remained unchanged. Oral administration of UDCA 750mg/ day resulted in normalization of liver function tests. The beneficial effect of UDCA on biliary cast associated cholestatic liver cholangiopathy, may be related to its hepatocytoprotective action, improvement in biliary acid secretion and immunomodulatory properties which reduce immune-related liver damage.

Knowing the predisposing factors that may be implicated in the biliary cast formation, it would be interesting to use the UDCA as prophylaxis in patients at risk of biliary cast syndrome.

Reference: Katsinelos P, Kountouras J, Chatzimavroudis G, Zavos C, Pilpilidis I, Paroutoglou G. Combined endoscopic and ursodeoxycholic acid treatment of biliary cast syndrome in a non-transplant patient. World J Gastroenterol 2008; 14(33): 5223-5225

http://www.wjgnet.com/1007-9327/14/5223.asp

Correspondence to: Dr. Panagiotis Katsinelos, Department of Endoscopy and Motility Unit, Central Hospital, Ethnikis Aminis 41, Thessaloniki 54635, Greece. gchatzim@med.auth.gr
Telephone: +30-2310-963341 Fax: +30-2310-210401

About World Journal of Gastroenterology

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.