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2015 ; 31
(3
): 178-84
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Update on Sclerosing Cholangitis in Critically Ill Patients
#MMPMID26468312
Kirchner GI
; Rümmele P
Viszeralmedizin
2015[Jun]; 31
(3
): 178-84
PMID26468312
show ga
BACKGROUND: ?Sclerosing cholangitis in critically ill patients' (SC-CIP) is a
cholestatic liver disease of unknown etiology and represents the most prevalent
form of secondary sclerosing cholangitis. METHODS: This overview is based on a
systematic review of the literature searching for 'secondary sclerosing
cholangitis', 'SC-CIP', 'cast syndrome', and 'ischemic cholangitis' in the
database PubMed. RESULTS: SC-CIP can develop in patients with sepsis and acute
respiratory distress syndrome during a long-term intensive care unit (ICU)
treatment. It is a rare cholestatic liver disease with a rapid progression to
liver cirrhosis and hepatic failure. SC-CIP is initiated by an ischemic injury to
the biliary tree with subsequent stenoses of biliary ducts, biliary casts, and
infections, often with multi-resistant bacteria. Mechanical ventilation with high
positive end-expiratory pressure, prone positioning, and a higher volume of
intraperitoneal fat have been proposed as risk factors for developing SC-CIP.
Patients with SC-CIP have a poor prognosis, with liver transplantation (LT) being
the only curative treatment option. CONCLUSION: In patients with sepsis,
long-term ICU therapy and ongoing cholestasis SC-CIP must be excluded by
endoscopic retrograde cholangiopancreatography. Due to the poor prognosis, the
option of LT should be evaluated in all patients with SC-CIP.