PROLONGED CHOLESTATIC JAUNDICE AFTER ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY

The main complications of endoscopic retrograde cholangiography and sp hincterotomy are bleeding, pancreatitis, perforation and sepsis. Two c ases of unexplained prolonged cholestatic jaundice in patients who und erwent endoscopic retrograde cholangiography (ERC) for biliary obstruc tion due to choledocholithiasis are reported. The patients were admitt ed because of right upper quadrant pain, vomiting and jaundice. Labora tory tests showed increased levels of total and conjugated serum bilir ubin and increased alkaline phosphatase. Ultrasound examination showed cholelithiasis and choledocholithiasis with bile duct dilatation. ERC with sphincterotomy was performed and gallstones obstructing the comm on bile duct were removed endoscopically. Following ERC and despite co mplete patency of the biliary tree, a progressive increase of total an d conjugated bilirubin and of alkaline phosphatase was noted, associat ed with itching and total stool discoloration. The insertion of nasobi liary drain did not improve the jaundice. Prednisolone treatment for 1 2 days was associated with progressive restoration of serum bilirubin and alkaline phosphatase to normal levels. It was postulated that the radiocontrast material used may have acted toxically on the liver with disruption of the canalicular plasma membrane. It is proposed that in tahepatic cholestasis should be added in the list of complications of endoscopic retrograde cholangiography.