Worsening cholestasis after endoscopic retrograde cholangiopancreatography

Prolonged cholestasis is a rare complication of endoscopic retrograde cholangiopancreatography [ERCP] with few cases reported in literature. A case of a 39-year-old Jordanian woman who presented with abdominal pain and jaundice was reported. Clinical investigations revealed cholestasis with dilatation of the intrahepatic biliary system. A cholecystectomy had been performed 15 years earlier. ERCP findings were consistent with a mild biliary obstruction. The symptoms were thought to be due to a biliary stone that had passed spontaneously. Her abdominal pain subsided and she was discharged. A few days later the patient's jaundice worsened and she developed severe pruritus. A viral and autoimmune screen were negative and a repeat abdominal ultrasound was normal. She was treated with ursodeoxycholic acid for 10 days, but with no improvement. The patient declined to undergo a liver biopsy. A dramatic improvement was achieved following a short course of oral corticosteroids