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Original research
Nasobiliary drainage: an effective treatment for pruritus in cholestatic liver disease
  1. Wafaa Ahmed,
  2. Rebecca Jeyaraj,
  3. David Reffitt,
  4. John Devlin,
  5. Abid Suddle,
  6. John Hunt,
  7. Michael A Heneghan,
  8. Phillip Harrison,
  9. Deepak Joshi
  1. Institute of Liver Studies, King's College Hospital NHS Trust, London, UK
  1. Correspondence to Dr Wafaa Ahmed, Institute of Liver Studies, King's College Hospital NHS Trust, London SE5 9RS, UK; wafaa.ahmed{at}nhs.net

Abstract

Introduction Nasobiliary drains (NBDs) have been successfully used to manage intrahepatic cholestasis, bile leaks and obstructive cholangitis. It allows external drainage of bile, bypassing the ileum where bile salts are reabsorbed. We assessed the utility of placement with effect on markers of cholestasis and patient symptoms.

Methods Consecutive patients undergoing NBD over 12 years for the management of pruritus were retrospectively analysed. Recorded variables included patient demographics, procedural characteristics and response to therapy.

Results Twenty-three patients (14, 61% male) underwent 30 episodes of NBD. The median age was 26 years old (range 2–67 years old). A single procedure was carried out in 20. One patient each had two, three and five episodes of NBD. The most common aetiologies were hereditary cholestatic disease (n=17, 74%) and drug-induced cholestasis (n=5, 22%),

NBD remained in situ for a median of 8 days (range 1–45 days). Significant improvement in bilirubin was seen at 7 days post-NBD (p=0.0324), maintained at day 30 (335 μmol/L vs 302 µmol/L vs 167 µmol/L). There was symptomatic improvement in pruritus in 20 (67%, p=0.0494) episodes. One patient underwent NBD during the first trimester of pregnancy after medical therapy failure with a good symptomatic response. The catheters were well tolerated in 27 (90%) of cases. Mild pancreatitis occurred in 4 (13%) cases.

Conclusion NBD can be used to provide symptomatic improvement to patients with pruritus associated with cholestasis. It is well tolerated by patients. They can be used in pregnancy where medical management has failed.

  • cholestatic liver diseases
  • bile
  • biliary endoscopy
  • diagnostic and therapeutic endoscopy

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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Footnotes

  • Twitter @thebiledoc@djosh78

  • Contributors WA wrote and prepared the manuscript. WA and RJ collected data. RJ, PH, JD, AS, JH and MAH reviewed and corrected the manuscript. DJ supervised, reviewed, edited and is the guarantor for the manuscript. All authors have read and agreed to the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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