Endoscopic Nasobiliary Drainage

Abstract

Four approaches are available for biliary drainage, including the surgical approach, percutaneous transhepatic approach, approach through the digestive tract, and transpapillary approach. Of these approaches, the transpapillary biliary drainage is often selected because of low invasiveness. There are two routes for this drainage: external drainage and internal drainage. The stents used include plastic stent and self-expandable metallic stent (SEMS). Depending on the stenotic lesion of the biliary tract, the bile duct is divided into the hilar bile duct and distal bile duct.

Endoscopic nasobiliary drainage (ENBD) is a transpapillary external biliary drainage technique, which was first performed in endoscopic retrograde cholangiopancreatography (ERCP) by Cotton et al. in 1979 (Gut 20:285–287, 1979). This technique is useful for examining the volume and color of the discharged bile, for identifying the etiologic bacterium in cholangitis, and for pathological examination. At present, ENBD is widely used for biliary decompression in patients with obstructive jaundice, for the treatment of acute cholangitis and biliary fistula after biliary tract surgery, and for the cytological examination of tumorous lesions in the biliary tract (Leung and Cotton, Am J Gatroenterol 86:389–394, 1991; Kawakami et al., J Gastroenterol 46:242–248, 2011; Lai et al., N Engl J Med 326:1582–1586, 1992; Yagioka et al., J Hepatobiliary Pancreat Sci 18:211–215, 2011; Uchida et al., J Gastroenterol Hepatol 23:1501–1504, 2008; Foutch et al., Gastrointest Endosc 39:416–421, 1993).