Endoscopic Retrograde Biliary Drainage Group Research Articles

A retrospective comparison of endoscopic nasobiliary drainage (ENBD) and endoscopic retrograde biliary drainage (ERBD) in the treatment of acute cholangitis

Endoscopic nasobiliary drainage (ENBD) and endoscopic retrograde biliary drainage (ERBD) can rapidly alleviate obstruction, facilitate bile drainage, and reduce pressure in the bile duct. In this study, to evaluate the effect of plastic biliary stent on the recurrence rate of choledocholithiasis in patients with actual cholangitis after endoscopic retrograde cholangioangiography (ERCP), we a comparative analysis of the efficacy and safety between ENBD and ERBD in inflammatory remission rate, complication rate, and success rate of secondary or multiple endoscopic lithotomy. A total of 347 patients undergoing ENBD and ERBD were enrolled in this retrospective study. Preoperative assessments including blood tests, electrocardiography, abdominal ultrasonography, CT scans, MRI, or MRCP were conducted on all participants. Additionally, serum CRP and amylase levels were measured using a magnetic nanobead-based immunoassay. We found that The success rate of stone removal in the ENBD group was higher than that in the ERBD group (90.8% vs. 72.7%) (P <0.0001). The remission rate of inflammation in the ERBD group (100.0%) was higher than that in the ENBD group (98.7%) (P >0.05). No significant difference was observed between the ERBD group and the ENBD group in preoperative and postoperative inflammatory indexes (total bilirubin, direct bilirubin, white blood cells, neutrophils, CRP, and serum amylase). Moreover, there were significant differences in post-ERCP pancreatitis between the ERBD group and ENBD group. These results suggest that both ENBD and ERBD can effectively improve clinical efficacy. Moreover, magnetic nanobeads have good application in serum index detection to increase detection efficiency.

The Optimal Type and Management of Biliary Drainage in Patients With Obstructive Jaundice Who Undergo Pancreaticoduodenectomy.

The aims of this study were to clarify optimal type and management of preoperative biliary drainage (PBD) in patients with obstructive jaundice who underwent pancreatoduodenectomy (PD). A total of 156 patients with obstructive jaundice who underwent PD were enrolled. We compared clinical variables and postoperative complications between patients who underwent endoscopic retrograde biliary drainage (ERBD) and those who underwent endoscopic nasobiliary drainage (ENBD). All patients underwent PBD, with ERBD in 117 and ENBD in 39. The incidence of infectious complications and clinically relevant pancreatic fistula (CR-PF) were significantly higher in the ERBD group (39% vs. 13%, p=0.012 and 39% vs. 10%, p<0.00001, respectively). However, there was no significant difference in the postoperative complications between two groups when the duration of drainage exceeded 30 days. ERBD should not be performed in patients with obstructive jaundice prior to PD because of the increased rates of infectious complications and CR-PF following PD, and ENBD should be chosen instead. Furthermore, PD should be performed within 30 days of drainage period in patients with ENBD.

Preoperative endoscopic retrograde biliary drainage increases postoperative complications after pancreaticoduodenectomy compared to endoscopic nasobiliary drainage.

Preoperative biliary drainage prior to pancreaticoduodenectomy (PD) by percutaneous transhepatic biliary drainage (PTBD) or endoscopic biliary drainage (EBD) is performed to improve liver functions, including immunity and coagulation that affect postoperative recovery in patients with jaundice. EBD can be performed through endoscopic retrograde biliary drainage (ERBD) or endoscopic nasobiliary drainage (ENBD). There is no clear consensus about which drainage is more suitable for preoperative EBD. The purpose of this study was to compare the postoperative outcomes of ENBD and ERBD performed prior to PD. Data were collected retrospectively from the medical records of 3 hospitals: Chuncheon, Kangdong and Kangnam Sacred Heart hospitals. From January 2007 to April 2019, PD was performed in 230 patients, among whom, 88 patients had undergone preoperative EBD. These 88 patients were divided into two groups according to the method of preoperative biliary drainage: ENBD versus ERBD. We compared clinical data and postoperative complications after PD between ENBD and ERBD. The overall complication rates in the ENBD group were significantly lower than in the ERBD group (26.1% vs. 57.1%, P=0.003). Postoperative pancreatic fistula (POPF) rates (11.1% vs. 38.1%, P=0.003) and postpancreatectomy hemorrhage (PPH) rates (2.2% vs. 14.3%, P=0.036) in the ENBD group were also lower than in the ERBD group. Our study provides further evidence that patients undergoing ERBD before PD are more likely to suffer POPFs and PPHs. This suggests that ENBD should be preferred in order to minimize the risk of POPFs and PPHs in patients with biliary obstruction prior to undergoing PD.

Application of endoscopic nasobiliary cutting in the treatment of hilar cholangiocarcinoma

Abstract Objective The aim of the study was to study the clinical efficacy and prognosis of endoscopically cutting the nasobiliary duct and leaving its residual segment as a biliary stent in the treatment of hilar cholangiocarcinoma (HC). Methods The clinical data of 55 patients with HC treated by endoscopic biliary drainage at the Gastrointestinal Endoscopy Center of our hospital (Renmin Hospital of Wuhan University, China) from August 2017 to August 2019 were retrospectively analyzed. According to different drainage schemes, patients were divided into the endoscopic nasobiliary cutting group (n = 26) and the endoscopic retrograde biliary drainage (ERBD) group (n = 29). The postoperative liver function indexes, incidence of postoperative complications, median patency period of stents, and median survival time of patients were compared between the two groups. Results Liver function indexes (total bilirubin, direct bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase) were significantly decreased in 55 patients a week postoperaticely (P &lt; 0.05), and decreases in liver function indexes in the endoscopic nasobiliary cutting group were more significant than those in the ERBD group (P &lt; 0.05). The incidence of biliary tract infection in the endoscopic nasobiliary cutting group was significantly lower than that in the ERBD group (15.40% vs. 41.4%, P &lt; 0.05). In the endoscopic nasobiliary cutting subgroups, there were 1 and 3 cases of biliary tract infection in the gastric antrum cutting group (n = 21) and duodenal papilla cutting group (n = 5), respectively, and 0 cases and 2 cases of displacement, respectively; there was a statistically significant difference in terms of complications between the two subgroups (P &lt; 0.05). The median patency period (190 days) and median survival time (230 days) in the nasobiliary duct cutting group were higher than those (169 days and 202 days) in the ERBD group, but there was no significant difference (P &gt; 0.05). Conclusion The nasobiliary duct was cut by using endoscopic scissors in Stage II after the bile was fully drained through the nasobiliary duct. The residual segment could still support the bile duct and drain bile. The reduction of jaundice and the recovery of liver enzymes were significant, and the incidence of biliary tract infection was low. Cutting off the nasobiliary duct at the duodenal papilla results in a higher incidence of biliary tract infection, and the residual segment of the nasobiliary duct is more likely to be displaced. Endoscopic nasobiliary-cutting drainage is an effective, simple, and safe method to reduce jaundice in the palliative treatment of HC.

Comparison between endoscopic retrograde biliary drainage and endoscopic nasobiliary drainage in treatment of acute cholangitis

Objective To compare the safety and effectiveness of endoscopic retrograde biliary drainage (ERBD) and endoscopic nasobiliary drainage (ENBD) in treatment of acute cholangitis. Methods A retrospective analysis was performed on data of 272 patients with acute cholangitis who underwent emergent endoscopic retrograde cholangiopancreatography (ERCP) in Beijing Chaoyang Hospital from January 2009 to June 2017. Patients were divided into ERBD group (n=143) and ENBD group (n=129) according to the drainage measures. In the ERBD group, there were 63 cases of grade Ⅰ (mild) acute cholangitis, 51 of grade Ⅱ (moderate), and 29 of grade Ⅲ (severe), and the corresponding cases in the ENBD group were 54, 37 and 38, respectively. The rate of improvement of inflammation, ERCP-related complications and interventions to drainage were compared between the two groups in all patients and each grade. Results The rates of improvement of inflammation in the ERBD group and the ENBD group were 89.5% (128/143) and 94.6% (122/129), respectively, in overall patients (χ2=2.399, P=0.126), 93.7% (59/63) and 98.1% (53/54), respectively, in grade Ⅰ patients (χ2=0.548, P=0.459), 90.2% (46/51) and 94.6% (35/37), respectively, in grade Ⅱ patients (χ2=0.125, P=0.724), and 79.3% (23/29) and 89.5% (34/38), respectively, in grade Ⅲ patients (χ2=0.657, P=0.418). The incidence of ERCP-related complications in the ERBD group and the ENBD group were 11.9% (17/143) and 7.8% (10/129), respectively, in overall patients (χ2=1.298, P=0.225), 9.5% (6/63) and 7.4% (4/54), respectively, in grade Ⅰ patients (χ2=0.006, P=0.939), 13.7% (7/51) and 8.1% (3/37), respectively, in grade Ⅱ patients (χ2=0.230, P=0.632), and 13.8% (4/29) and 7.9% (3/38), respectively, in grade Ⅲ patients (χ2=0.144, P=0.705). There were no significant differences in the rate of improvement of inflammation and ERCP-related complications between the two groups. The incidences of interventions to drainage in the ERBD group and the ENBD group were 10.5% (15/143) and 3.1% (4/129), respectively, in overall patients (χ2=5.699, P=0.017), 6.3% (4/63) and 1.9% (1/54), respectively, in grade Ⅰ patients (χ2=0.548, P=0.495), 9.8% (5/51) and 5.4% (2/37), respectively, in grade Ⅱ patients (χ2=0.125, P=0.724), and 20.7% (6/29) and 2.6% (1/38), respectively, in grade Ⅲ patients (χ2=3.965, P=0.046). There were significant differences in the incidence of interventions to drainage between the two groups in overall and grade Ⅲ patents. Conclusion ERBD and ENBD are equally safe and effective in treatment of different grades of acute cholangitis, but ENBD can reduce the incidence of interventions to drainage. Key words: Cholangiopancreatography, endoscopic retrograde; Stent; Nasobiliary drainage; Acute cholangitis

Endoscopic Retrograde Biliary Drainage Causes Intra-Abdominal Abscess in Pancreaticoduodenectomy Patients: An Important But Neglected Risk Factor.

Patients with periampullary cancer frequently suffer obstructive jaundice and commonly require preoperative biliary drainage (PBD) for relief and to avoid related complications. Although research has established a correlation between PBD and surgical wound infection, the impact of PBD on major infectious complications (intra-abdominal abscess [IAA]) and overall mortality remains debatable. We hypothesized that PBD could lead to IAA and mortality, and evaluated their correlation in patients undergoing pancreaticoduodenectomy (PD). We enrolled patients undergoing PD at an Asian academic medical center between 2007 and 2016. The types of PBD included endoscopic retrograde biliary drainage (ERBD) and percutaneous transhepatic cholangiography and drainage (PTCD). The primary outcome was IAA, defined as the presence of pus or infected fluid inside the abdominal cavity and with documented infectious pathogens. There was one (0.1%) 30-day mortality and eight (0.9%) 90-day mortalities among 899 consecutive patients examined. More than one-quarter of patients had PBD (n = 237, 26.4%; 165 ERBD, 72 PTCD). In the ERBD, PTCD, and non-PBD groups, the IAA rates were 37.0%, 16.7%, and 10.6%, respectively. On multivariate analysis, ERBD (odds ratio 3.67; 95% confidence interval 2.22-6.06; p < 0.001) was the only significant factor associated with IAA. No significant factor was found to analyze variables associated with mortality. ERBD, but not PTCD, is associated with an increased risk of IAA in patients undergoing PD, which suggests that ERBD should be avoided whenever possible to prevent IAA. Further randomized clinical trials should be conducted to validate this relationship.

Comparison of the safety and effectiveness of endoscopic biliary decompression by nasobiliary catheter and plastic stent placement in acute obstructive cholangitis

Endoscopic retrograde biliary drainage (ERBD) using a plastic stent is suggested to be as effective as endoscopic nasobiliary drainage (ENBD) with a nasobiliary catheter for temporary biliary drainage in acute obstructive cholangitis. However, there are few studies that have compared the two methods. We therefore compared the safety and effectiveness of endoscopic biliary decompression by nasobiliary catheter versus plastic stent placement in these patients. A total of 94 screened patients with acute obstructive cholangitis were randomised to undergo emergency endoscopic biliary drainage with ENBD (n = 47) or ERBD (n = 47). Clinical outcomes and adverse events were compared. Patient backgrounds were similar in the two groups. Endoscopic biliary drainage was successfully achieved in all patients. Eleven patients underwent unscheduled endoscopic retrograde cholangiopancreatography (ERCP) to replace the nasobiliary catheter, 10 due to a catheter (1 in the ENBD group) or stent (9 in the ERBD group) blockage and 1 due to catheter migration. Clinical manifestations were similar, however, there was a significantly lower patient discomfort score in the ERBD group (p <0.05). The mean serum gamma-glutamyltransferase and total bilirubin concentrations after ERCP were significantly higher in the ERBD than ENBD group (p <0.001). Complication rates were similar in the ENBD and ERBD groups. However, the incidence rate of blockage in ERBD was statistically higher than ENBD (p = 0.015). Endoscopic biliary decompression is an effective treatment for patients with acute obstructive cholangitis. In contrast to other studies, we found an increased rate of blockage in the ERBD group and a greater decrease in liver enzyme levels in the ENBD group.

Biliary drainage for obstructive jaundice caused by unresectable hepatocellular carcinoma: the endoscopic versus percutaneous approach

For palliative treatment of the obstructive jaundice associated with unresectable hepatocellular carcinoma (HCC), percutaneous transhepatic biliary drainage (PTBD) or endoscopic retrograde biliary drainage (ERBD) has been performed. PTBD is preferred as an initial procedure. Little is known about the better option for patients with obstructive jaundice caused by unresectable HCC. Sixty patients who had received ERBD or PTBD for the palliative treatment of obstructive jaundice caused by unresectable HCC between January 2006 and May 2010 were included in this retrospective study. Successful drainage, drainage patency, and the overall survival of patients were evaluated. Univariate analysis revealed that the overall frequency of successful drainage was higher in the ERBD group (22/29, 75.9%) than in the PTBD group (15/31, 48.4%) (P=0.029); but multivariate analysis showed marginal significance (P=0.057). The duration of drainage patency was longer in the ERBD group than in the PTBD group (82 vs 37 days, respectively, P=0.020). Regardless of what procedure was performed, the median survival time of patients who had a successful drainage was much longer than that of the patients who did not have a successful drainage (143 vs 38 days, respectively, P<0.001). Besides PTBD, ERBD may be used as the initial treatment option to improve obstructive jaundice in patients with unresectable HCC if there is a longer duration of drainage patency after a successful drainage.

Sphincter of Oddi‐preserving and T‐Tube‐free Laparoscopic Management of Extrahepatic Bile Duct Calculi

The current management of choledocholithiasis remains a controversial topic. Popular options for treatment include preoperative endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) followed by laparoscopic cholecystectomy (LC), or LC and laparoscopic common bile duct exploration (LCBDE) with T-tube decompression. Some concerns suggest that sphincterotomy has significant long-term complications as a result of sphincter of Oddi (SO) dysfunction, and T-tube decompression is historically associated with many complications and discomfort. The purpose of this study was to demonstrate our simple, safe techniques of LCBDE without a T-tube and with an intact SO. Between April 2006 and July 2009, a total of 44 selected patients with common bile duct (CBD) stones underwent laparoscopic exploration at our institution. Of 44 laparoscopic choledochotomies, primary choledochorrhaphy was performed on patients with preoperatively installed endoscopic retrograde biliary drainage (ERBD) tubes (n = 10, 22.73%) or endonasobiliary drainage (ENBD) tubes (n = 10, 22.73%) and on patients with intraoperative biliary drainage C-tubes (n = 9, 20.45%) or pigtail J biliary drainage tubes (n = 15, 34.09%). The mean operating time for the ENBD, ERBD, J-tube, and C-tube groups were 97.8, 96.2, 102.1, and 98.7 min, respectively. There were no conversions to open surgery, and no intraoperative complications were experienced in any group. CBD clearance was achieved in 43 patients (97.73%). The mean lengths of follow-up for the ENBD, ERBD, J-tube, and C-tube groups were 27.0, 26.7, 23.8, and 30.4 months, respectively; and none of the patients developed major biliary complications including recurrent stones. Laparoscopic primary closure with internal and external biliary drainage tubes is safe and an effective alternative to T-tube placement, especially for younger patient groups able to endure bile duct exploration. Sphincter of Oddi function is well preserved to prevent recurrent bile duct stones and bile duct cancer. Procedures are safe with great feasibility.

The safety and effectiveness of endoscopic biliary decompression by plastic stent placement in acute suppurative cholangitis compared with nasobiliary drainage

Endoscopic retrograde biliary drainage (ERBD) by using a plastic stent is suggested to be as effective as endoscopic nasobiliary drainage (ENBD) for temporary biliary drainage in acute suppurative cholangitis (ASC). However, there are few studies that compared ERBD and ENBD in ASC. We compared the safety and efficacy of ERBD and ENBD for temporary biliary drainage in patients with ASC. A case series. A tertiary-referral center. Eighty patients with ASC underwent endoscopic biliary drainage with ENBD (n = 41) and ERBD (n = 39). Clinical outcomes, including complications related to ERCP and complications related to the type of the indwelling catheter. Endoscopic biliary drainage was successfully achieved in all patients (100%). There were no significant differences in the demographic data between the 2 groups. There were no differences in the improvement of clinical and laboratory parameters between the 2 groups. Overall ERCP-related complication rates in the ENBD and ERBD groups were 31.7% and 38.5%, respectively (P = .527). Hyperamylasemia occurred in 18 patients, 12.2% in the ENBD group (5/41) and 33.3% in the ERBD group (13/39) (P = .024). Without endoscopic sphincterotomy (EST), there was no statistically significant difference in the incidence of hyperamylasemia between the 2 groups. However, with an EST, hyperamylasemia was more frequent in the ERBD group (12/28 [42.9%]) than in the ENBD group (3/27 [11.1%]) (P = .008). A single-center experience. Endoscopic biliary decompression, whether by ERBD or ENBD, is an effective treatment for patients with ASC. However, more frequent hyperamylasemia with ERBD and EST deserves further evaluation.

Improvement in oil cans, or feeders

For palliative treatment of the obstructive jaundice associated with unresectable hepatocellular carcinoma (HCC), percutaneous transhepatic biliary drainage (PTBD) or endoscopic retrograde biliary drainage (ERBD) has been performed. PTBD is preferred as an initial procedure. Little is known about the better option for patients with obstructive jaundice caused by unresectable HCC.Sixty patients who had received ERBD or PTBD for the palliative treatment of obstructive jaundice caused by unresectable HCC between January 2006 and May 2010 were included in this retrospective study. Successful drainage, drainage patency, and the overall survival of patients were evaluated.Univariate analysis revealed that the overall frequency of successful drainage was higher in the ERBD group (22/29, 75.9%) than in the PTBD group (15/31, 48.4%) (P=0.029); but multivariate analysis showed marginal significance (P=0.057). The duration of drainage patency was longer in the ERBD group than in the PTBD group (82 vs 37 days, respectively, P=0.020). Regardless of what procedure was performed, the median survival time of patients who had a successful drainage was much longer than that of the patients who did not have a successful drainage (143 vs 38 days, respectively, P<0.001).Besides PTBD, ERBD may be used as the initial treatment option to improve obstructive jaundice in patients with unresectable HCC if there is a longer duration of drainage patency after a successful drainage.