North Texas Research Forum 2024



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North Texas


Medical City Arlington


Internal Medicine

Document Type


Publication Date



cholangiopathy, COVID -19, SARS-CoV-2, Endoscopic Retrograde Cholangiopancreatography, ERCP


Digestive System Diseases | Internal Medicine | Medicine and Health Sciences | Virus Diseases


Introduction: Post COVID-19 cholangiopathy (CC) is a rare complication of COVID-19 infection. It is characterized by abnormal elevation of serum alkaline phosphatase, with evidence of bile duct injury (via imaging or biopsy) in the absence of other causes. Not much is known regarding the role of ERCP in post COVID-19 cholangiopathy. We sought to better understand the findings, interventions and outcomes in patients with CC undergoing ERCP. Methods: We searched Pubmed, Scopus and Embase from December 2019 to present. Search words included "post-Covid-19 cholangiopathy," and “ERCP.” Data on patient characteristics, COVID-19 infection, imaging, ERCP fluoroscopic findings, ERCP interventions, post ERCP complications, and outcomes were collected. Results: We identified 11 case reports of patients diagnosed with CC who underwent ERCP, including nine men and two women. The average age was 50 years. Most patients had severe COVID-19 infection requiring mechanical ventilation. The average peak laboratories were alkaline phosphatase 1601, total bilirubin 11.8, and ALT 223. The most common findings on ERCP were biliary tree strictures (64%), biliary stones (55%), casts (36%) and sludge (36%). The most common intervention performed during the ERCPs were stone extraction (55%), sphincterotomy (27%), and stent placement (9%). Following ERCP, two of the 11 patients were given ursodiol with subsequently improved LFTs. None of the cases reported post ERCP pancreatitis. Two patients ultimately underwent liver transplantation. Discussion: In patients with CC, ERCP appears to be a safe and effective treatment. Reported indications for ERCP are similar to non-COVID 19 related cases, such as biliary obstruction, abnormal imaging, concern for biliary strictures and stones. The most common findings during ERCP in CC are strictures, stones, and biliary casts. Finding common bile duct stones does not rule out CC. Biliary casts seem to more common in CC patients than in the general population. Interventions are common in CC ERCPs. The most common intervention performed was stone or cast extraction. Although the diagnosis would be expected to be established prior to ERCP, CC may be a unique entity were ERCP is diagnostic. ERCP for CC appears to be safe with no reports of post ERCP pancreatitis. This study is limited by the small number of cases included. ERCP can be considered in CC patient with findings that would warrant therapeutic intervention such as, biliary stones, casts, or strictures.

Original Publisher

HCA Healthcare Graduate Medical Education

The Role of ERCP in Post Covid-19 Cholangiopathy: A Systemic Review of Published Case Reports



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