Abstract
ObjectivesWe investigated the clinical efficacy of a modified nasobiliary fixation and drainage technique which was designed in an attempt to reduce unplanned extubation and tube blockage and improve bile drainage and the comfort of catheterized patients.MethodsFrom January 2019 to December 2020, 230 patients receiving Endoscopic nasobiliary drainage (ENBD) during hospitalization were recruited to this study. Participants were randomly allocated to 2 groups by using the block randomization method: in the control group: the conventional method of nasobiliary fixation was adopted after surgery; in the test group: intraoperative annular cutting of nasobiliary tubes was performed and the exposed catheter length was standardized. The modified “tube-nose-ear” three-step technique was performed after surgery. The clinical efficacy of a modified nasobiliary fixation and drainage technique was evaluated and compared between the test group and the control group.ResultsThe rate of unplanned extubation and incidence of complications were significantly lower in the test group than the control group. In addition, the rate of bilirubin decrease after drainage was higher in the test group. Patient discomfort during catheterization was also significantly reduced using the modified technique (P < 0.05).ConclusionsThe modified technique of nasobiliary fixation and drainage technique can significantly reduce unplanned extubation and nasobiliary tube blockage after ENBD, facilitate biliary drainage, and improve patient comfort. This technique warrants wider application in clinical practice.
Highlights
Endoscopic retrograde cholangiopancreatography (ERCP) is widely used in pancreatic and biliary disease treatment as it is minimally invasive, safe, effective, and can facilitates rapid rehabilitation [1,2,3]
Inclusion criteria were as follows: [1] typical clinical characteristics of biliary system disease such as abdominal pain, jaundice, and vomiting, and receiving ERCP+Endoscopic nasobiliary drainage (ENBD) after diagnosis by magnetic resonance imaging (MRI); [2] 18–65 years old; [3] inpatient with nasobiliary tube indwelling after ERCP; [4] informed consent to drainage and intervention; [5] ability to cooperate closely with postoperative treatment and evaluation
Our research group modified the nasobiliary fixation and drainage technique according to the primary reasons for unplanned extubation documented in previous cases, and assessed the efficacy of this new “tube-nose-ear” threestep fixation method in a controlled clinical trial
Summary
Endoscopic retrograde cholangiopancreatography (ERCP) is widely used in pancreatic and biliary disease treatment as it is minimally invasive, safe, effective, and can facilitates rapid rehabilitation [1,2,3]. Endoscopic nasobiliary drainage (ENBD) [4, 5] can quickly relieve bile duct obstruction [6, 7], control infection, and cure disease [8]. Many scholars have continuously explored and provided new methods of nasobiliary duct fixation [15], the irritation of the tape to the skin and the patient’s comfort during catheterization were overlooked. Unplanned extubation and poor drainage are still common in clinical patients with nasobiliary duct. To reduce unplanned extubation rate, facilitate biliary drainage, and improve patient comfort during catheterization, our team modified the nasobiliary fixation and drainage technique for ENBD patients according to a retrospective analysis of failure cases (Patent No ZL201420497025.2). We evaluated the feasibility and safety of the modified technique for clinical application
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