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.

Source: World Journal of Gastroenterology