The study on the effect of endoscopic nasobiliary drainage (ENBD) and endoscopic retrograde biliary drainage (ERBD) on obstructive jaundice

Abstract

Objective To compare the effect of endoscopic nasobiliary drainage (ENBD) and endoscopic retrograde biliary drainage (ERBD) on intestinal mucosal barrier function of patients with obstructive jaundice in clinical practice.Methods Forty patients with significant jaundice due to obstructive disorders of biliary tract and 20 health volunteers as controls were recruited.At the baseline,serum diamine oxidase (DAO) was measured with ultraviolet spectrophotometer,while endotoxin and tumor necrosis factorα (TNF-α) were determined with endotoxin detector and enzyme-linked immunosorbent assay (ELISA)kits,respectively.Forty patients were then divided randomly into ENBD and ERBD groups (n =20 patients per group).Dynamic changes in serum DAO,endotoxin and TNF-α were observed postoperatively.Results In the patients with obstruction of biliary tract,higher serum bilirubin,γ-glutamyl transpeptidas (γ-GT),alkaline phosphatase (ALP),DAO,endotoxin,and TNF-α were found preoperatively relative to those in health control (P ＜ 0.05).After operation,ERBD and ENBD had comparable effect on improving serum bilirubin,γ-GT and ALP,while serum DAO,endotoxin and TNF-α in each group were dramatically decreased.In day 1 after operation,there was no significant difference in serum DAO,endotoxin and TNF-α between two groups.However,in day 3 and 7 after operation,serum DAO,endotoxin and TNF-α in ENBD group were significantly higher than those in ERBD group (P ＜ 0.05).Conclusions It was suggested that ERBD and ENBD have comparable effects on removing obstruction of biliary tract and draining bile.However,ERBD might have greater benefits than ENBD in improving intestinal mucosal barrier function,and thus would be more beneficial in preventing systemic inflammatory response. Key words: Jaundice, obstructive ; Drainage ; Intestinal mucosa/physiopathology; Toxemia; Systemic inflammatory response syndrome