Evaluation of the Change in Liver Stiffness after Biliary Drainage in Patients with Extrahepatic Cholestasis

Year 2021, Volume: 38 Issue: 3, 260 - 265, 01.05.2021

Fatih Uzunkaya , Ayşegül İdil Soylu , İbrahim Gören , Ahmet Polat , Ahmet Bektaş

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.

Keywords

Extrahepatic cholestasis, liver stiffness, ARFI elastography

References

• Attia, D., Pischke, S., Negm, AA, Rifai, K., Manns, MP, Gebel, MJ, et al., 2014. Changes in liver stiffness using acoustic radiation force impulse imaging in patients with obstructive cholestasis and cholangitis. Dig Liver Dis. 46, 625¬¬–31.
• Bota, S., Sporea, I., Peck-Radosavljevic, M., Sirli, R., Tanaka, H., Iijima, H., et al., 2013. The influence of aminotransferase levels on liver stiffness assessed by Acoustic Radiation Force Impulse Elastography: a retrospective multicentre study. Dig Liver Dis. 45, 762–8.
• Choi, M., Kwon, H., Cho, J,. Oh, J., Nam, K., Kang, M., et al., 2014. Serial change of liver stiffness measured by acoustic radiation force impulse imaging in chronic liver disease: correlation with biochemical markers. J Med Ultrason. 41, 311–7.
• Darweesh, SK, Zayed, N., Atef, M., Ramzy, E., Yousry, A., Musa S., 2020. Increased liver stiffness by transient elastography and acoustic radiation force impulse imaging in patients with extrahepatic cholestasis. Eur J Gastroenterol Hepatol. Online ahead of print. doi: 10.1097/MEG.0000000000001881.
• Friedrich-Rust, M., Nierhoff, J., Lupsor, M., Sporea, I., Fierbinteanu-Braticevici, C., Strobel, D., et al., 2012. Performance of acoustic radiation force impulse imaging for the staging of liver fibrosis: a pooled meta-analysis. J Viral Hepat. 19, e212–9.
• Gujral, JS, Farhood, A., Bajt, ML, Jaeschke H., 2003. Neutrophils aggravate acute liver injury during obstructive cholestasis in bile duct-ligated mice. Hepatology. 38, 355–63.
• Harata, M., Hashimoto, S., Kawabe, N., Nitta, Y., Murao, M., Takuji N., et al., 2011. Liver stiffness in extrahepatic cholestasis correlates positively with bilirubin and negatively with alanine aminotransferase. Hepatol Res. 41, 423–9.
• Kubo, K., Kawakami, H., Kuwatani, M., Nishida, M., Kawakubo, K., Kawahata, S., et al., 2016. Liver elasticity measurement before and after biliary drainage in patients with obstructive jaundice: a prospective cohort study. BMC Gastroenterol. 16, 65.
• Millonig, G., Reimann, FM, Friedrich S., Fonouni, H., Mehrabi, A., Büchler MV, et al., 2008. Extrahepatic cholestasis increases liver stiffness (FibroScan) irrespective of fibrosis. Hepatology. 48, 1718–23.
• Pfeifer, L., Strobel, D., Neurath, MF, Wildner, D., 2014. Liver stiffness assessed by acoustic radiation force impulse (ARFI) technology is considerably increased in patients with cholestasis. Ultraschall in Med. 35, 364–7.
• Seo, YS, Lee, KG, Jung, ES, An, H., Park, S., Keum, B., et al., 2010. Dynamic changes in liver stiffness during the course of acute hepatitis A. Scand J Gastroenterol. 45, 449–56.
• Sporea I., 2017. The new EFSUMB Guidelines on Liver Elastography 2017: why and for whom? Med Ultrason. 19, 5–6.
• Trifan, A., Sfarti, C., Cojocariu, C., Dimache, M., Cretu, M., Hutanasu, C., et al., 2011. Increased liver stiffness in extrahepatic cholestasis caused by choledocholithiasis. Hepat Mon. 11, 372–5.
• Yashima, Y., Tsujino, T., Matsuzaki, R., Nakai, Y., Hirano, K., Tateishi, R., et al., 2011. Increased liver elasticity in patients with biliary obstruction. Gastroenterol. 46, 86–91.
• Yoon, KT, Lim, SM, Park, JY, Kim, DY, Ahn, SH, Han, KH, et al., 2012. Liver stiffness measurement using acoustic radiation force impulse (ARFI) elastography and effect of necroinflammation. Dig Dis Sci. 57, 1682–91.