COVID-19 related biliary injury: A review of recent literature

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.

Clinical and Histopathological Discoveries in Patients with Hepatic Injury and Cholangiopathy Who Have Died of COVID-19: Insights and Opportunities for Intervention

“… 84 Additionally, disease severity and the need for ICU admission have been linked to an increased risk of cholangiopathy. 85 These findings suggest that certain demographic and clinical factors contribute to the development of cholangiopathy in individuals affected by COVID-19.…”

“…Post-COVID-19 cholangiopathy is a novel entity that has been increasingly reported in the literature. [85][86][87][88][89][90][91][92][93][94] upon those basis, we conducted a scoping review of the literature, and Table 1 presents the findings as a summary of study characteristics for reports on cholangiopathy in COVID-19, with additional summaries for histopathological findings (Table 2) and MRCP/ERCP findings (Table 3). These investigations have documented various manifestations of biliary system involvement, including persistent liver dysfunction, cholestasis, and biliary abnormalities.…”