Table 1 Summary of study characteristics and patients’ demographic, clinical, and imaging information
From: Features of biliary tract diseases in ketamine abusers: a systematic review of case reports
No. | Study reference | Age, sex, country | Medical history | Signs and symptoms | LFT | Ketamine abuse pattern and duration | Imaging findings | Other studies | Treatment | Outcome |
|---|---|---|---|---|---|---|---|---|---|---|
1 | Gutkin et al. [1] 2012 | 18, F, China | Alcohol abuse | N/V, abdominal tenderness | AST 472 IU/L ALT 330 IU/L GGT 226 IU/L | Three times per week for 4 years | US: dilated CBD CT: wall thickening of the gallbladder and dilated common bile duct to 14 mm, without evidence of stones or other obstructing lesions | Cytology: normal. Ampullary biopsy: normal | ERCP: papillotomy | Discharged: normal LFT |
2 | Gutkin et al. [1] 2012 | 27, M, China | None | N/V, severe abdominal pain, dysuria, abdominal tenderness | Normal | 3 g per day doses | US: dilated CBD CT: CBD 7.4 mm MRCP: mild intrahepatic biliary dilatation, moderate extrahepatic dilatation, CBD 11 mm | Cytology: normal. Ampullary biopsy: normal | ERCP: sphincterotomy | Discharged: symptom free after ketamine cessation |
3 | Turkish et al. [2] 2013 | 21, M, USA | ARF | Fever, abdominal pain, abnormal liver function | Elevated | Daily for 9 months | US: diffusely echogenic liver with normal portal vein blood flow CT: normal MRCP: normal | Liver biopsy: concentric preductal fibrosis consistent with primary or secondary sclerosing cholangitis, with mild lymphocytic infiltrates and a mild ductular reaction, but no cholestasis was identified | Drug rehabilitation program | Discharged: mild elevation of ALP with normal intra- or extra-hepatic bile ducts |
4 | Lo et al. [3] 2011 | 27, M, UK | ARF | Abdominal pain, tachypnea, tachycardia, | ALT 106 IU/L | For 4 years | US: bilateral hydronephrosis and nephrostomies CT: bilateral hydronephrosis and biliary dilatation Chest radiography: bilateral basal consolidation HIDA: diminished gall bladder ejection fraction | None | Intubation, hemofiltration, and antibiotics, ERCP | Discharged: total resolution of hydronephrosis and the absence of any biliary dilatation |
5 | Lo et al. [3] 2011 | 27, M, UK | None | Colicky epigastric pain | ALT 75 IU/L | 6 mg daily in split doses for 2 years | US: normal Cystoscopy: red, edematous, and ulcerated bladder mucosa HIDA: normal | None | Catheterization | Discharged: lost to follow-up |
6 | Lo et al. [3] 2011 | 26, M, UK | None | Nocturia, hematuria, and increased urinary frequency | ALT 44–266 IU/L | For 7 years | US: liver and biliary tree were normal Cystoscopy: erythromateous CT and IVU: bilateral hydronephrosis and bilateral hydroureters HIDA: no appreciable filling of the gallbladder | Biopsy: inflammation | Long-term catheterization | Discharged: Gallbladder dyskinesia |
7 | Wong et al. [4] 2009 | 21, F, Hong Kong | None | Recurrent epigastric pain | ALT 333 IU/L | 1 once per 1–2 months for 18 months | US: dilated CBD and normal gallbladder CT: fusiform dilatation CHD and CBD up to 9 mm in diameter MRCP: dilatation of CBD Gastroscopy: mild antral gastritis | None | Biliary drainage | Discharged: MRCP showed resolution of CBD diameter of 4 mm and normal LFT |
8 | Wong et al. [4] 2009 | 27, M, Hong Kong | Choledochal cyst | Recurrent epigastric pain | ALT 75 IU/L | Twice a week for 2 years | Gastroscopy: mild gastric erosion CT: CBD dilatation up to 17 mm MRCP: Fusiform dilatation of CBD and CHD | Cytology: normal | ERCP: plastic biliary stent | Discharged: decreased CBD diameter and discharged with no pain |
9 | Wong et al. [4] 2009 | 23, M, Hong Kong | NA | Colicky epigastric pain and ketamine-associated cystitis | Normal | 1 once per week for 3 months | CT: fusiform dilatation CHD and CBD up to 11.2 mm in diameter US: N/A | None | Conservative therapy | Discharged |
10 | Zhou et al. [5] 2013 | 38, M, UK | Well-controlled HIV, asthma and HTN, alcohol abuse | Acute-on-chronic epigastric pain, nausea and vomiting | ALT 131 IU/L | 1–2 g a day for a year | Endoscopy and barium studies: normal MRCP: dilatation of CBD, mild cholangiopathy, no gallstones ERCP: no obstructive lesion | Duodenal biopsies: normal | ERCP: sphincterotomy | Discharged: reduction in CBD diameter and normal LFT |
11 | Zhou et al. [5] 2013 | 25, M, UK | HIV positive, alcohol abuse, UTI | Intermittent right upper quadrant pain and nausea | ALT 418 IU/L GGT 1015 IU/L | 1 g 2–3 times per week for 12 months | US: CBD dilation, normal liver and pancreas MRCP: CBD dilatation of 14 mm; normal gallbladder, no intra-ductal stones ERCP: normal | Liver biopsy: a non-cirrhotic liver, no features of HIV cholangitis, opportunistic infections, or alcohol toxicity | ERCP: sphincterotomy | Discharged: pain subsequently resolved and LFTs normalized within 2 months of stopping ketamine |
12 | Seto et al. [6] 2011 | 32, F, China | UTI | On-and-off epigastric discomfort | GGT 284 U/l | For 7 years | ERCP: multiple long-segment strictures and narrowing in the intrahepatic ducts of both lobes, CBD dilation, pancreatic duct was normal | -Brush cytology: only reactive changes -Liver biopsy: mild nonspecific inflammation of the portal tracts -Colonoscopy with biopsies: normal | ERCP | N/A |
13 | Cheung et al. [7] 2014 | 20, F, Hong Kong | None | Right upper quadrant pain, nausea and fever | ALT 178 U/L | For 2 years | CT: CBD dilatation, evidence of hepatic micro-abscesses ERCP: persistent ultra-short narrowing was noted at the very distal portion of CBD, where sphincter of Oddi would be located | None | ERCP: sphincterotomy, sphincteoplasty | Discharged |
14 | Al-Nowfal et al. [8] 2016 | 24, F, UK | None | Intermittent right upper quadrant pain associated with nausea and malaise | NA | For 4 years | US: dilated CBD and normal gallbladder MRCP: no gallstones and normal CBD | None | Opiate analgesics and antispasmodics | Discharged |
15 | Aslam et al. [9] 2019 | 24, F, UK | UTI | Right upper quadrant pain, | ALT 521 U/L | N/A | MRCP: bilateral ureteric thickening, moderate intrahepatic biliary dilatation and strictures, with thickening of the common duct wall and a stricture of the inferior common duct US: diffuse thickening of the common duct | None | N/A | Discharged: reduction in biliary dilatation and LFT |
16 | Nyirenda et al. [10] 2020 | 32, M, UK | None | Jaundice, rigors, and decreased appetite, right hypochondrium pain and tender hepatomegaly | ALT 203 U/L AST 86 U/L GGT 2050 U/L | Daily for 15 years | MRCP: dilated bile ducts with no filling defects, gallstones or strictures US: normal CT: normal | None | ERCP: plastic stent | Discharged: improved LFT |
17 | Lui et al. [11] 2014 | 28, M, Hong Kong | None | Deranged liver function test results | ALT 183 IU/L GGT 1088 IU/L | For 5 years | US: dilated CBD with a gallstone ERCP: 5 cm stricture at the lower end of the CBD together with small bilateral segmental strictures in the intrahepatic ducts | -Brush cytology: normal -Liver biopsy: mild-to-moderate portal fibrosis with ductular proliferation and periportal copper deposits -Colonoscopy: normal | ERCP: plastic stent | Discharged: improved LFT |