Journal of Gastroenterology

, Volume 46, Issue 2, pp 242–248

Endoscopic nasobiliary drainage is the most suitable preoperative biliary drainage method in the management of patients with hilar cholangiocarcinoma

  • Hiroshi Kawakami
  • Masaki Kuwatani
  • Manabu Onodera
  • Shin Haba
  • Kazunori Eto
  • Nobuyuki Ehira
  • Hiroaki Yamato
  • Taiki Kudo
  • Eiichi Tanaka
  • Satoshi Hirano
  • Satoshi Kondo
  • Masahiro Asaka
Original Article—Liver, Pancreas, and Biliary Tract

DOI: 10.1007/s00535-010-0298-1

Cite this article as:
Kawakami, H., Kuwatani, M., Onodera, M. et al. J Gastroenterol (2011) 46: 242. doi:10.1007/s00535-010-0298-1
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Abstract

Background

Controversy exists over the preferred technique of preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCA). The goal of this retrospective study was to identify the preferred technique of PBD for HCA.

Methods

A total of 128 consecutive patients with HCA diagnosed between September 1999 and December 2009 who underwent PBD were included in this study. The study compared outcomes of endoscopic nasobiliary drainage (ENBD), endoscopic biliary stenting (EBS), and percutaneous transhepatic biliary drainage (PTBD) in patients with HCA.

Results

There were no significant differences in preoperative laboratory data, rates of major hepatectomy, or decompression periods among the 3 groups. Complications were significantly more frequent in the EBS group compared with either the ENBD or PTBD group (p < 0.05). Drainage tube occlusion with cholangitis was significantly more common in the EBS group compared with either the ENBD or PTBD group (p < 0.0001). Patients in the PTBD group experienced serious complications including vascular injury (8%) and cancer dissemination (4%). Patients in the ENBD and EBS groups had mild post-endoscopic retrograde cholangiopancreatography pancreatitis (5%). Conversion procedures were significantly more common in the EBS group compared with the ENBD and PTBD groups (p < 0.05). There was no significant difference in postsurgical morbidity or mortality among the 3 groups.

Conclusions

Drainage tube occlusion with cholangitis was a frequent complication associated with EBS. PTBD was associated with serious complications such as vascular injury and cancer dissemination. ENBD was found to be the most suitable method for initial PBD management in patients with HCA.

Keywords

Hilar cholangiocarcinomaPreoperative biliary drainageEndoscopic biliary drainageEndoscopic nasobiliary drainagePercutaneous transhepatic biliary drainage

Abbreviations

PTBD

Percutaneous transhepatic biliary drainage

PBD

Preoperative biliary drainage

ENBD

Endoscopic nasobiliary drainage

EBS

Endoscopic biliary stenting

ERCP

Endoscopic retrograde cholangiopancreatography

ICG

Indocyanine green

EBD

Endoscopic biliary drainage

EST

Endoscopic sphincterotomy

HCA

Hilar cholangiocarcinoma

Copyright information

© Springer 2010

Authors and Affiliations

  • Hiroshi Kawakami
    • 1
  • Masaki Kuwatani
    • 1
  • Manabu Onodera
    • 1
  • Shin Haba
    • 1
  • Kazunori Eto
    • 1
  • Nobuyuki Ehira
    • 1
  • Hiroaki Yamato
    • 1
  • Taiki Kudo
    • 1
  • Eiichi Tanaka
    • 2
  • Satoshi Hirano
    • 2
  • Satoshi Kondo
    • 2
  • Masahiro Asaka
    • 1
  1. 1.Department of GastroenterologyHokkaido University Graduate School of MedicineSapporoJapan
  2. 2.Department of Surgical OncologyHokkaido University Graduate School of MedicineSapporoJapan