title: The safety and efficacy of nasobiliary drainage in the treatment of refractory cholestatic pruritus: a multicentre European study.
abstract: BACKGROUND
  Pruritus is a common symptom associated with cholestatic liver diseases. To date only small single centre case series have suggested efficacy of nasobiliary drainage in relieving cholestatic pruritus.
  
  
  OBJECTIVE
  To perform a multicentre study to evaluate the safety and efficacy of nasobiliary drainage in cholestatic pruritus.
  
  
  METHODS
  This was a retrospective study of all patients treated with nasobiliary drainage for refractory cholestatic pruritus between 2006 and 2015 at five European centres. Pruritus was quantified using a visual analogue scale (VAS) and liver enzymes, serum bilirubin and total serum bile salts (TBS) were measured before (pre-NBD) and after nasobiliary drainage (post-NBD). We analysed the duration of treatment response and associated complications.
  
  
  RESULTS
  In total, 27 patients (59% females) underwent 29 nasobiliary drainage procedures. The median duration of NBD was 7 days. NBD decreased pruritus in 89.6% of cases (VAS from 10.0 to 0.3, P < 0.0001). The median percentage decline in pruritus VAS was 94% and 33% of patients were free of pruritus within 24 h of starting drainage. The duration of treatment response was independent of duration of drainage (P = 0.12) and bile output. Significant improvements were seen in the median levels of serum alkaline phosphatase (P = 0.001) and serum bilirubin (P = 0.03) but not in serum TBS (P = 0.07). Mild post-endoscopic retrograde cholangiopancreatography pancreatitis (31%) was the most frequent complication.
  
  
  CONCLUSIONS
  Nasobiliary drainage is effective in relieving cholestatic pruritus in most patients and has favourable effect on biomarkers of cholestasis. Nasobiliary drainage may be associated with high risk of adverse events, especially pancreatitis. Prospective studies are needed to confirm our findings.
authors.affiliation: Freeman Hospital, The Newcastle upon Tyne NHS Foundation Trust and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: V S
authors.initials: VS
authors.lastname: Hegade
authors.affiliation: Department of Medicine II, Saarland University Medical Center, Homburg, Germany.|Laboratory of Metabolic Liver Diseases, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Krawczyk
authors.affiliation: Department of Medicine I, Friedrich-Alexander-University of Erlangen, Erlangen, Germany.
authors.forename: A E
authors.initials: AE
authors.lastname: Kremer
authors.affiliation: Department of Medicine I, Friedrich-Alexander-University of Erlangen, Erlangen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Kuczka
authors.affiliation: Service d'Hépatologie, Centre de référence des Maladies Inflammatoires des voies biliaires, Hôpital Saint-Antoine, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Gaouar
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: E M M
authors.initials: EM
authors.lastname: Kuiper
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: H R
authors.initials: HR
authors.lastname: van Buuren
authors.affiliation: Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Lammert
authors.affiliation: Service d'Hépatologie, Centre de référence des Maladies Inflammatoires des voies biliaires, Hôpital Saint-Antoine, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Corpechot
authors.affiliation: Freeman Hospital, The Newcastle upon Tyne NHS Foundation Trust and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: D E J
authors.initials: DE
authors.lastname: Jones
mesh_terms: D000328:Adult; D001646:Bile / Q000378:metabolism; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D002779:Cholestasis / Q000150:complications*; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D011537:Pruritus / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies