Endosonographic and ERCP findings in COVID-19 critical illness cholangiopathy.

A 56-year-old female developed deep jaundice months after struggling with critical illness, needing hemodialysis, and tracheostomy, due to COVID-19. Lab tests included alkaline phosphatase 1574U/L, total bilirubin 11mg/dL, ALT 88U/L, AST 101U/L. Baseline liver tests were normal before illness. ANA, IgG4 level, and viral hepatitides were negative. The patient was unable to tolerate MRCP due to dyspnea, and CT-contrast could not be done due to renal disease. EUS and ERCP were pursued. EUS showed a left hepatic duct stricture and heterogenous, non-shadowing cylindric objects in the main bile duct. ERCP confirmed LHD stricture with upstream dilation of the left ducts, and obliteration of right intrahepatics with secondary sclerosing changes. Brushings and biopsies of the stricture ruled out malignancy. Casts were swept. The left lobe was stented with a 10 Fr 20 cm plastic stent improving bilirubin level to a baseline of 3 mg/dl. Critical illness cholangiopathy results in secondary sclerosing cholangitis. In this case, it is unclear whether the patient suffered these changes as a direct cause of COVID-19 or as a result of critical illness cholangiopathy. The overall prognosis is guarded given its progressive nature and likely need for liver transplantation.

Progress and challenges in the comprehensive management of chronic viral hepatitis: Key ways to achieve the elimination.

Chronic viral hepatitis is a significant health problem throughout the world, which already represents high annual mortality. By 2040, chronic viral hepatitis due to virus B and virus C and their complications cirrhosis and hepatocellular carcinoma will be more deadly than malaria, vitellogenesis-inhibiting hormone, and tuberculosis altogether. In this review, we analyze the global impact of chronic viral hepatitis with a focus on the most vulnerable groups, the goals set by the World Health Organization for the year 2030, and the key points to achieve them, such as timely access to antiviral treatment of direct-acting antiviral, which represents the key to achieving hepatitis C virus elimination. Likewise, we review the strategies to prevent transmission and achieve control of hepatitis B virus. Finally, we address the impact that the coronavirus disease 2019 pandemic has had on implementing elimination strategies and the advantages of implementing telemedicine programs.