title: Initial experience of transnasal endoscopic biliary drainage without conscious sedation for the treatment of acute cholangitis (with video).
abstract: BACKGROUND
  Endoscopic biliary drainage has been established as providing effective treatment for acute obstructive jaundice and cholangitis. A recently developed ultrathin transnasal videoendoscope is less invasive, even for patients who were critically ill, and can be performed without conscious sedation.
  
  
  OBJECTIVE
  To evaluate the clinical efficacy and safety of biliary drainage (BD) by using transnasal videoendoscopy (TNE) without conscious sedation.
  
  
  METHODS
  Case series.
  
  
  METHODS
  This procedure was performed at Tokyo Medical University Hospital.
  
  
  METHODS
  Three patients with bile-duct stones and acute cholangitis and with a previous biliary endoscopic sphincterotomy (ES) were included in this study.
  
  
  METHODS
  All patients underwent BD by using a front-viewing TNE. Two 5F stents were placed into the bile duct across the major papilla.
  
  
  METHODS
  The efficacy and safety of the TNE technique.
  
  
  RESULTS
  Transnasal insertion of a TNE endoscope was feasible in all patients, without epistaxis. TNE BD was achieved in all patients. Abdominal pain, fever, and jaundice improved 24 hours after the procedure in all patients. Despite the absence of intravenous conscious sedation, all patients would agree to undergo the procedure again, if necessary.
  
  
  CONCLUSIONS
  Maneuverability of the TNE endoscope; limited to patients with a previous ES.
  
  
  CONCLUSIONS
  In this small series, unsedated TNE can be used to successfully drain the biliary system in patients with a previous ES. Additional studies to validate this hypothesis are needed.
authors.affiliation: Department Gastroenterology and Hepatology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawai
authors.forename: Fumihide
authors.initials: F
authors.lastname: Itokawa
authors.forename: Atushi
authors.initials: A
authors.lastname: Sofuni
authors.forename: Toshio
authors.initials: T
authors.lastname: Kurihara
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Tsuchiya
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ishii
authors.forename: Shujiro
authors.initials: S
authors.lastname: Tsuji
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Ikeuchi
authors.forename: Mami
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakai
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu
mesh_terms: D000208:Acute Disease; D000368:Aged; D002761:Cholangitis / Q000209:etiology / Q000601:surgery*; D016292:Procedural Sedation; D004322:Drainage / Q000379:methods*; D016099:Endoscopy, Gastrointestinal; D042882:Gallstones / Q000150:complications; D006801:Humans; D008297:Male; D015607:Stents