Diagnostic Imaging and Treatment for Sclerosing Cholangitis in Critically-ill Post-COVID-19 Patients: A Literature Review

By Zaid Al-Ghazawi, Helen Huang, Sadan Abdulfattah, Ayush Anand, Muhammad Adnan Khan, Sonia Mukhtar



Al-Ghazawi Z, Huang H, Abdulfattah S, Anand A, Adnan Khan M, Mukhtar S. Diagnostic imaging and treatment for sclerosing cholangitis in critically-ill post-COVID-19 patients: a literature review. HPHR. 2022;67.  

Diagnostic Imaging and Treatment for Sclerosing Cholangitis in Critically-ill Post-COVID-19 Patients: A Literature Review

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  • Post COVID-19 cholangiopathy is a form of sclerosing cholangitis in critically ill patients (SC-CIP)1,2
  • SC-CIP is rare in ICU but dismal; up to half of the patients die during the ICU stay and with rapid progression to liver cirrhosis 3
  • The diagnosis is often missed by clinicians and treatment is limited 4
  • Due to the COVID-19 pandemic, the outcomes of SC-CIP remains a public health concern in ICU management

Aim and Purpose

Review current diagnostic and treatment modalities in post-COVID-19 cholangiopathy to improve screening and risk management

Lin T, Qu K, Xu X, et al. Sclerosing cholangitis in critically ill patients: an important and easily ignored problem based on a German experience. Front Med. 2014;8(1):118-126. doi:10.1007/s11684-014-0306-6


  • Multiple electronic databases were searched using these keywords:

–(“COVID-19” OR “2019 novel coronavirus” OR “2019-nCoV” OR “SARS-CoV-2″) AND

–(“cholangitis” OR “secondary sclerosing cholangitis” OR “cholangiopathy”)

  • 32 articles were screened and 7 were excluded due to duplication


  • 25 relevant articles from 2020-present were reviewed to identify the diagnostic and treatment modalities for patients with post-COVID-19 cholangiopathy



Public Health Implication

➢Longer-term consequences after SARS-CoV-2 infection are becoming an important burden to societies and healthcare systems

➢Post-COVID-19 cholangiopathy decreases the quality of life for patients

➢Post-COVID-19 sclerosing cholangitis is underrepresented and if missed, could progress to fatal cirrhotic complications

Health Equity Implication

➢Increased awareness and timely diagnosis via imaging is crucial to improve the outcomes of post-COVID-19 cholangiopathy and must be available

➢Liver transplantation are the most effective treatment but concerns regarding health inequity and inaccessibility must be addressed

➢Socioeconomic factors can impact organ transplant accessibility in low-resource settings

Future Direction

➢Treatment options must be further explored to provide better outcomes for the general population and prevent the progression of cirrhosis

➢Future studies should look at the outcome and prognosis of patients receiving liver transplants to better quantify risks and quality of life


We would like to thank Larkin Hospital Team 11 Research Group for this opportunity to present at the Boston Congress of Public Health


1.Edwards K, Allison M, Ghuman S. Secondary sclerosing cholangitis in critically ill patients: a rare disease precipitated by severe SARS-CoV-2 infection. BMJ Case Rep. 2020;13: 237984. doi:10.1136/BCR-2020-237984

2.Roth NC, Kim A, Vitkovski T, Xia J, Ramirez G, Bernstein D, et al. Post-COVID-19 Cholangiopathy: A Novel Entity. Am J Gastroenterol. 2021;116: 1077–1082. doi:10.14309/AJG.0000000000001154

3.Martins P, Verdelho Machado M. Secondary Sclerosing Cholangitis in Critically Ill Patients: An Underdiagnosed Entity. GE – Portuguese Journal of Gastroenterology. 2019;27(2):103-114.

4.Faruqui S, Okoli FC, Olsen SK, Feldman DM, Kalia HS, Park JS, et al. Cholangiopathy After Severe COVID-19: Clinical Features and Prognostic Implications. Am J Gastroenterol. 2021;116: 1414–1425. doi:10.14309/AJG.0000000000001264

5.Durazo FA, Nicholas AA, Mahaffey JJ, Sova S, Evans JJ, Trivella JP, et al. Post-Covid-19 Cholangiopathy-A New Indication for Liver Transplantation: A Case Report. Transplant Proc. 2021;53: 1132–1137. doi:10.1016/J.TRANSPROCEED.2021.03.007

6.Gossard AA, Angulo P, Lindor KD. Secondary sclerosing cholangitis: a comparison to primary sclerosing cholangitis. Am J Gastroenterol. 2005;100: 1330–1333. doi:10.1111/J.1572-0241.2005.41526.X

7.Lee A, Wein AN, Doyle MBM, Chapman WC. Liver transplantation for post-COVID-19 sclerosing cholangitis. BMJ Case Rep. 2021;14. doi:10.1136/BCR-2021-244168

8.Ruemmele P, Hofstaedter F, Gelbmann CM. Secondary sclerosing cholangitis. Nat Rev Gastroenterol Hepatol. 2009;6: 287–295. doi:10.1038/NRGASTRO.2009.46

9.Gelbmann CM, Rümmele P, Wimmer M, Hofstädter F, Göhlmann B, Endlicher E, et al. Ischemic-like cholangiopathy with secondary sclerosing cholangitis in critically ill patients. Am J Gastroenterol. 2007;102: 1221–1229. doi:10.1111/J.1572-0241.2007.01118.X

10.Klindt C, Jensen BE, Brandenburger T, Feldt T, Killer A, Schimmöller L, et al. Secondary sclerosing cholangitis as a complication of severe COVID-19: A case report and review of the literature. Clin case reports. 2021;9. doi:10.1002/CCR3.4068

About the Authors

Zaid Al-Ghazawi

Helen Huang

Sadan Abdulfattah

Ayush Anand

Muhammad Adnan Khan

Sonia Mukhtar