Biliary Interventions in critically ill patients with Sclerosing Cholangitis

• Applicant: Professor Dr. Heiner Wedemeyer, since 4/2022
• Subject Area: Gastroenterology
• Term: from 2021 to 2024
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 417222376

Secondary sclerosing cholangitis (SSC) is characterized by progressive destruction of the biliary tree caused by a wide variety of stimuli including but not limited to toxic and infectious agents, immune-mediated mechanisms, and ischemia. SSC often leads to recurrent cholangitis, cirrhosis, hepatic decompensation, hepatobiliary malignancy and death. Recently, a new sub-entity of SSC has been defined in critically ill patients (SSC–CIP). With advances in critical care SSC-CIP is now being observed with increasing frequency in ICU patients and those who have recently survived critical illness seriously impeding their long-term outcome. While the pathogenesis is largely unknown the most commonly employed therapeutic approach is repeated endoscopic retrograde cholangiography (ERC) with removal of biliary casts from the biliary system and dilatation of strictures. Nonetheless SSC-CIP often progresses to end-stage disease; in this case liver transplantation is a therapeutic option in selected patients. Another major and often eventually fatal complication of SSC-CIP is recurrent cholangiosepsis. To date, efficacy of endoscopic interventions has not been proven and a standard therapy is not available for patients with SSC-CIP. In fact, it is thus far unclear whether repeated biliary interventions improve the course of SSC-CIP or even lead to a deterioration of the disease by promoting ascending bacterial cholangitis. This is a clinically highly relevant question that needs to be answered through systematic study in order to deliver better care to patients with SSC-CIP.We hypothesize that programmed endoscopic therapy compared to a conservative strategy that aims to avoid biliary intervention and hence introduction of gut microbes into the biliary system reduces the occurrence of treatment failures defined as death or necessity of liver transplantation or development of cholangiosepsis 6 months after randomization.

• DFG Programme: Clinical Trials
• Co-Investigator: Professorin Dr. Kristina Ringe
• Ehemaliger Antragsteller: Privatdozent Dr. Torsten Voigtländer, until 4/2022