Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Sep 7, 2008; 14(33): 5223-5225
Published online Sep 7, 2008. doi: 10.3748/wjg.14.5223
Combined endoscopic and ursodeoxycholic acid treatment of biliary cast syndrome in a non-transplant patient
Panagiotis Katsinelos, Jannis Kountouras, Grigoris Chatzimavroudis, Christos Zavos, Ioannis Pilpilidis, George Paroutoglou
Panagiotis Katsinelos, Grigoris Chatzimavroudis, Ioannis Pilpilidis, George Paroutoglou, Department of Endoscopy and Motility Unit, Central Hospital, Thessaloniki 54635, Greece
Jannis Kountouras, Christos Zavos, Department of Gastroenterology, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki 54635, Greece
Author contributions: Katsinelos P, Kountouras J, Chatzimavroudis G, Zavos C, Pilpilidis I, Paroutoglou G contributed equally to the work; Katsinelos P, Kountouras J, Chatzimavroudis G and Zavos C wrote the paper; Pilpilidis I and Paroutoglou G selected the bibliography.
Correspondence to: Dr. Panagiotis Katsinelos, Department of Endoscopy and Motility Unit, Central Hospital, Ethnikis Aminis 41, Thessaloniki 54635, Greece.
Telephone: +30-2310-963341 Fax: +30-2310-210401
Received: May 23, 2008
Revised: July 12, 2008
Accepted: July 19, 2008
Published online: September 7, 2008

A 76-year-old diabetic man underwent cholecystectomy for gangrenous calculous cholecystitis. His postoperative course was complicated by the development of Candida albicans esophagitis necessitating antifungal therapy, and total parenteral nutrition (TPN) for 15 d. Seven weeks after cholecystectomy, he presented with cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated extrahepatic filling defects. Despite endoscopic extraction of a biliary cast, cholestasis remained unchanged. Oral administration of ursodeoxycholic acid (UDCA), 750 mg/d, resulted in normalization of liver function tests. We, therefore, propose for the first time, combined endoscopic plus UDCA treatment for the management of biliary cast syndrome.

Keywords: Biliary cast, Ursodeoxycholic acid, Endoscopic retrograde cholangiopancreatography