Application of endoscopic nasobiliary drainage in preoperative reduction of jaundice for hilar cholangiocarcinoma

Abstract

Objective To evaluate the efficacy and safety of endoscopic nasobiliary drainage (ENBD) in preoperative reduction of jaundice in patients with hilar cholangiocarcinoma. Methods Clinical data of 8 patients with hilar cholangiocarcinoma who underwent ENBD for preoperative reduction of jaundice in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from October 2018 to February 2019 were retrospectively analyzed. Among them, 6 patients were male and 2 female, aged from 53 to 74 years with a median age of 59. The informed consents of all patients were obtained and the local ethical committee approval was received. The ENBD success rate, effect of jaundice reduction and complications were observed. TB levels before and after ENBD were statistically compared by rank sum test. Results ENBD was successfully performed in 8 patients including 4 cases of left hepatic duct drainage, 3 cases of right hepatic duct drainage and 1 case of bilateral duct drainage. Pancreatic duct stent was placed in 1 case to prevent postoperative pancreatitis. No patient underwent sphincterotomy of duodenal papilla. The median operation time of ENBD was 56(15-134) min, the bile drainage volume was 565(248-1 235) ml/d, the drainage time was 24(16-73) d. TB level after ENBD was 57(39-78) μmol/L, significantly lower than 283(144-563) μmol/L before ENBD (Z=-2.52, P<0.05). Segmental cholangitis occurred in 2 cases after ENBD, who were cured after antibiotic treatment. No pancreatitis, hemorrhage or perforation was observed. Preoperatively, TB level was decreased to below 68.4 μmol/L in 6 patients and below 51.3 μmol/L in 2 cases. After jaundice reduction, 6 cases underwent R0 resection, 1 case received R1 resection, and the tumor could not be resected in 1 case. One patient developed abdominal infection and liver failure after operation, who was recovered after anti-infection and liver protection therapy. The remaining 7 patients were well recovered without postoperative complications. Conclusions Preoperative ENBD is an efficacious and safe approach to reduce jaundice in patients with hilar cholangiocarcinoma, which can increase surgical safety and reduce the incidence of surgical complications. During ENBD, endoscopic sphincterotomy of duodenal papilla should be avoided. Pancreatic duct stent should be placed when necessary to prevent the postoperative pancreatitis. Key words: Bile duct neoplasms; Hilar cholangiocarcinoma; Endoscopic nasobiliary drainage; Jaundice