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COVID-19 related biliary injury: A review of recent literature
Sujani Yadlapati1, Simone A Jarrett2, Daniel Baik3
1Department of Gastroenterology, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ 08103, United States. yadlapati-sujani@cooperhealth.edu.
Insights
Coronavirus 2019 (COVID-19) can cause severe biliary tract injury, known as COVID-19 cholangiopathy. This condition presents weeks to months after infection, potentially leading to liver failure.
Area of Science:
- Gastroenterology and Hepatology
- Infectious Diseases
- Pathology
Background:
- Coronavirus 2019 (COVID-19) infection commonly involves multiple organ systems, including the hepatobiliary tract.
- While most patients experience mild liver enzyme elevations, severe cholestatic injury and liver failure have been reported, particularly in critically ill patients.
Purpose of the Study:
- To review the existing literature on COVID-19 cholangiopathy, a severe form of biliary tract injury occurring after COVID-19 infection.
- To summarize proposed pathophysiology, diagnostic criteria, and long-term implications of this condition.
Main Methods:
- Literature review of reported cases and existing data on COVID-19 cholangiopathy.
- Analysis of proposed etiological mechanisms, including direct cholangiocyte injury, vascular compromise, and cytokine release syndrome.
Main Results:
- COVID-19 cholangiopathy is characterized by significant elevations in alkaline phosphatase and bilirubin, with radiologic evidence of bile duct injury.
- The condition typically manifests weeks to months post-infection, resembling sclerosing cholangitis in imaging and pathology.
- Potential mechanisms include direct viral effects on bile duct cells, impaired blood supply, and systemic inflammatory responses.
Conclusions:
- COVID-19 cholangiopathy represents a serious, delayed complication of COVID-19 infection, potentially leading to devastating liver consequences.
- Further research is needed to elucidate the exact etiology and establish optimal management strategies for this emerging clinical entity.
Abstract:
Since its emergence in 2019, it has become apparent that coronavirus 2019 (COVID-19) infection can result in multi systemic involvement. In addition to pulmonary symptoms, hepatobiliary involvement has been widely reported. Extent of hepatic involvement ranges from minor elevation in liver function tests (LFTs) to significant hepatocellular or cholestatic injury. In majority of cases, resolution of hepatic injury or improvement in LFTs is noted as patients recover from COVID-19 infection. However, severe biliary tract injury progressing to liver failure has been reported in patients requiring prolonged intensive care unit stay or mechanical ventilation. Due to the timing of its presentation, this form of progressive cholestatic injury has been referred to as COVID-19 cholangiopathy or post-COVID-19 cholangiopathy, and can result in devastating consequences for patients. COVID-19 cholangiopathy is recognized by dramatic elevation in serum alkaline phosphatase and bilirubin and radiologic evidence of bile duct injury. Cholangiopathy in COVID-19 occurs weeks to months after the initial infection and during the recovery phase. Imaging findings and pathology often resemble bile duct injury associated with primary or secondary sclerosing cholangitis. Etiology of COVID-19 cholangiopathy is unclear. Several mechanisms have been proposed, including direct cholangiocyte injury, vascular compromise, and cytokine release syndromes. This review summarizes existing data on COVID-19 cholangiopathy, including reported cases in the literature, proposed pathophysiology, diagnostic testing, and long-term implications.
