Nasobiliary Drainage for Benign Recurrent Intrahepatic Cholestasis in Patients Refractory to Standard Therapy

Abstract

Purpose: Benign recurrent intrahepatic cholestasis (BRIC) is characterized by episodic cholestasis and pruritus without anatomical obstruction. The aim of this study was to evaluate the safety and efficacy of nasobiliary drainage (NBD) in patients with BRIC refractory to medical therapy and to determine whether the use of NBD prolongs the episode duration.
 
 Methods: This was a multicenter retrospective study consisting of 33 patients suffering from BRIC. All patients were administrated medical treatment and 16 patients who were refractory to standard medical therapies improved on treatment with temporary endoscopic NBD. Duration of treatment response and associated complications were analyzed.
 
 Results: Sixteen patients (43% females) underwent 25 NBD procedures. The median duration of NBD was 17 days. There were significant improvements in total and direct bilirubin and alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and gamma-glutamyl transpeptidase on the 3rd day of NBD. Longer clinical remission was monitored in the NBD group. Post-endoscopic retrograde cholangiopancreatography pancreatitis was observed in one of 16 cases.
 
 Conclusion: NBD effectively eliminates BRIC in all patients and improves biomarkers of cholestasis. It can be suggested that patients with attacks of BRIC can be treated with temporary endoscopic NBD; however, the results of this study should be confirmed by prospective studies in the future.

Gamma-Glutamyl Transferase: A Friend against Cholestatic Itch? A Retrospective Observational Data Analysis in Patients with Extrahepatic Cholestasis

“…GGT is a routinely requested serum parameter, and GGT data are available in many other studies that focused on cholestatic itch [3,5,8,[17][18][19][20][21][22]. However, in these studies, an association between cholestatic itch and GGT has not been reported.…”

“…This can be due to several study-specific issues. First, many authors only included patients with itch, thus, making a comparison with findings in nonitching patients impossible [19][20][21][22]. In our study, we selected patients based on the presence of cholestasis which led to inclusion of patients with and without itch.…”

The Mystery of Episodic Recurrent Jaundice in a Young Male: Cholestasis With a Normal Gamma-Glutamyl Transferase

“…Yakar et. al reported a series of 16 patients refractory to medical therapy who had temporary nasobiliary drains placed with resultant improvement in liver enzymes and pruritis within three days of the procedure [ 10 ]. Plasmapheresis and extracorporeal liver support therapy have also been used successfully in a few cases of BRIC and helped resolve the cholestasis episodes [ 11 ].…”

Benign Recurrent Intrahepatic Cholestasis (BRIC): An African Case Report

“…Bile acid sequestrants such as cholestyramine, opioid antagonists, and ursodeoxycholic acid may reduce pruritus but not the duration of episodes [2,14]. Rifampicin, plasmapheresis, and endoscopic nasobiliary drainage have all been shown to relieve symptoms and shorten episodes [4,15].…”