CHOLANGIOSCOPY IN A POST-COVID-19 CHOLANGIOPATHY PATIENT.

Main textAcute liver chemistry elevations occur frequently in patients with coronavirus disease 2019 (COVID-19) (1) .An unusual condition of secondary sclerosing cholangitis in critically ill patients has been recognized as a novel entity after COVID-19 infection (2) and recently named post-COVID-19 cholangiopathy.It is characterized by marked cholestasis associated with ongoing jaundice that persists long after pulmonary and renal recovery (3) .This E-VIDEO describes a SpyGlass ® cholangioscopy in a post-Covid-19 cholangiopathy patient.A 65-year-old men with diabetes, hypertension, and chronic lymphocytic leukemia, under hematologic follow-up, was hospitalized for COVID-19 associated acute respiratory distress syndrome 10 months prior, and underwent mechanical ventilation for 13 days under Fentanyl, Midazolam, and Ketamine sedation.10 days after hospital admission, he presented progressive increase of canalicular enzymes without transaminases or ultrasound abnormalities.At day 33 he was discharged, and his laboratory bloody tests included alkaline phosphatase of 807, gamma glutamyl transferase of 1831, and total bilirubin of 1.3. 1 month later he presented jaundice and progressive bilirubin increase, being started ursodeoxycholic acid without improvement.Endoscopic retrograde cholangiopancreatography (ERCP) revealed rarefaction of intrahepatic bile ducts (FIGURE 1), and removal of biliary casts (FIGURE 2).Patient did not show improvement of the condition, and cholangioscopy was indicated to endoscopically evaluate the bile duct and verify its viability.The procedure demonstrated scar retraction areas (FIGURE 3), as well as dark endothelial shedding, removed with Spybite®.In the confluence of the hepatic ducts, edema and diffuse ischemic pattern (FIGURE 4) was noted with retractions that cause important stenosis extending to intrahepatic segments (FIGURE 5).