[A case of secondary sclerosing cholangitis following endoscopic submucosal dissection ulcer bleeding].

A 75-year-old male patient underwent endoscopic submucosal dissection (ESD) for early gastric cancer. The ESD ulcer bleeding occurred 7 days post-ESD, and he underwent endoscopic clipping hemostasis. Afterward, the patient presented with acute cholecystitis and cholangitis, thereby developing sclerosing cholangitis. His hepatic failure worsened and he died 15 months post-ESD although we performed endoscopic dilations for bile duct stenosis and administered antibiotics. We considered the condition to be related to secondary sclerosing cholangitis in critically ill patients (SSC-CIP) caused by bile duct ischemia and cholangitis.

Usefulness of procalcitonin for severity assessment in patients with acute cholangitis.

BACKGROUND: The aim of the present study was to examine the usability of procalcitonin (PCT) for severity assessment in patients with acute cholangitis (AC). METHODS: Serum PCT concentrations were measured on admission in patients with AC. Patients were classified with mild, moderate, or severe AC based on severity assessment guidelines. RESULTS: We included 159 treatment-naïve patients with AC (95 males, 64 females) in this study. The median PCT concentrations were 0.08 ng/mL (interquartile range (IQR) 0.04 - 0.18 ng/mL), 0.37 ng/mL (IQR 0.15 - 1.85 ng/mL), and 5.56 ng/mL (IQR 3.59 - 25.89 ng/mL) in patients with mild, moderate and severe AC, respectively. PCT concentrations were significantly higher in patients with severe AC than in patients with moderate AC (p < 0.0001), and in patients with moderate AC than in patients with mild AC (p < 0.0001). The areas under the receiver operating characteristic curves for PCT to discriminate patients with moderate and severe AC were 0.84 (95% CI 0.77 to 0.92, p < 0.001) and 0.86 (95% CI 0.78 to 0.92, p < 0.001), respectively. CONCLUSIONS: Serum PCT concentrations were elevated in patients with AC and may be a useful parameter for the severity assessment of AC.