Endoscopic nasobiliary drainage improves jaundice attack symptoms in benign recurrent intrahepatic cholestasis: A case report.

[benign recurrent intrahepatic cholestasis]

A 66 -year -old male with unbearable pruritus and jaundice was admitted for detailed examination . Blood tests on admission showed increased bilirubin with a dominant direct fraction . Ultrasonography and computed tomography performed subsequent to admission showed no narrowing or distension of the bile ducts . As the jaundice symptoms were not improved by the oral administration of ursodeoxycholic acid (300 mg /day ) that had been started immediately after admission , endoscopic retrograde cholangiopancreatography (ERCP ) was performed on hospital day 14 . This also showed no abnormalities of the bile ducts . After considerating its potential effects for improving jaundice , endoscopic nasobiliary drainage (ENBD ) was performed on the same day and was followed by immediate improvements in pruritus and jaundice . Detailed examinations were performed to identify the cause of the jaundice , which was suspected to be viral hepatitis , autoimmune hepatitis or drug-induced liver injury , however , there were no findings suggestive of any of these conditions . Following a further increase in bilirubin levels , confirmed by additional blood tests , a liver biopsy was performed . Histological findings were consistent with the histological features of benign recurrent intrahepatic cholestasis (BRIC ). Although ursodeoxycholic acid is used as a first -line treatment in most cases of BRIC , ENBD should also be considered for patients not responding to this treatment .