Evaluation of the change in liver stiffness after biliary drainage in patients with extrahepatic cholestasis

Abstract

Increased liver stiffness (LS) due to extrahepatic cholestasis has been reported to reduce after biliary drainage. As far as we know, it has not been evaluated whether the method of drainage makes a difference in the change in liver stiffness until now. The aim of the study was to answer this question. The patients planned for endoscopic biliary drainage (EBD) or percutaneous biliary drainage (PBD) were enrolled for over an 18-months’ time period. In those without chronic liver disease or liver tumor, liver stiffness was measured before and 10 days after the intervention, using acoustic radiation force impulse (ARFI) elastography. A total of 30 patients were included in the study excluding the ones not fulfilling the criteria and were divided into two groups: EBD group (n = 15) and PBD group (n = 15). The measurements were above the cut-off value for severe fibrosis (1.55 m/s) in all patients with a mean of 2.50 ± 0.72 m/s before drainage. The pre-drainage values of the PBD group were significantly higher than of the EBD group (2.79 ± 0.58 m/s vs 2.22 ± 0.74 m/s, p = 0.02). In all patients except 11, a significant reduction was observed in the stiffness values. The reduction with PBD was more significant than with EBD (p = 0.04). Percutaneous biliary drainage provided a more significant reduction in liver stiffness in patients with extrahepatic cholestasis. However, this result appears to be related to the nature of obstruction rather than the method of drainage, making the comparison weaker than expected from the original design.