Evaluation of the Safety, Successfullness and Effectiveness of Endoscopic Nasobiliary Drainage (ENBD) without Endoscopic Sphicterotomy (EST)

Lee, Moon Sung; Kim, Hong Soo; Kim, Jin Hong; Cho, Sung Won; Shim, Chan Sup

Abstract

Endoscopic nasobiliary drainage(ENBD) has been developed as a safe and effective noninvasive biliary drainage method for initial decompression in the benign or malignant biliary obstruction, dissolution of biliary stones by injection of litholytic agents through the tube, and proper causative diagnosis of biliary obstruction by cytologic, bacteriologic and parasite investigation of drained bile. Generally, endoscopic sphicterotomy (EST) is performed before the insertion of an ENBD tube in order to make the procedure easy and to prevent acute pancreatitis that may develop by compression of the pancreatic orifice of the inserted tube. Nevertheless, in some cases EST is difficult to perform or should not be performed due to their coagulopathy. In such cases, ENBD without EST may be necessary. To evaluate the safety, successfullness and effectiveness of ENBD without EST, ENBD without EST using 5, 6 or 7 Fr pigtail tubes were performed in 81 cases(49 malignant, 32 benign). ENBD without EST was successfully performed in 78 out of 81 cases(96.3%). This effectiveness for decompression of bile duct, evaluated by decreasing total bilirubin values, was good in 66 out of 73 casee (90. 2%). The complications of this procedure were noted in 6 out of 78 cases(7. 7%). e. g. cholangitis in 3, migration of ENBD tube in 2, acute pancreatitis in 1 case. Particularly, regardless of our concern that ENBD without EST may develop acute pancreatitis acute panereatitis was noted in only one case. In conclusion, ENBD without EST is a safe and effective method which can be applied to the cases who have benign or malignant obstructive jaundice.