Efficacy of preoperative endoscopic nasobiliary drainage for hilar cholangiocarcinoma.
OBJECTIVE
Although percutaneous transhepatic biliary drainage has previously been recommended as a primary preoperative step, endoscopic nasobiliary drainage (ENBD) is prevalent as an alternative procedure. Few reports assess the efficacy and safety of ENBD in a substantial patient cohort.


METHODS
Of 116 patients with hilar cholangiocarcinoma who underwent surgery, 62 (43 men and 19 women, median age 69 years) underwent preoperative ENBD. After classification of lesions according to Bismuth-Corlette (B-C) criteria, we evaluated efficacy and safety with respect to B-C type.


RESULTS
Patients were classified as B-C types I (n = 5), II (n = 21), IIIa (n = 23), IIIb (n = 5), and IV (n = 8). Preoperative single ENBD was effective in 46/62 patients (74%) including 5/5 (100%) B-C type I, 20/21 (94%) type II, 16/23 (70%) type IIIa, 4/5 (80%) type IIIb, and 1/8 (13%) type IV. Sixteen cases (26%) required additional drainages with ENBD or endoscopic biliary stenting (EBS) in 8/16 (50%), and with PTBD in 8/16 (50%). Mild acute pancreatitis (n = 1, 2%), segmental cholangitis (n = 2, 3%), and acute cholangitis with catheter obstruction (n = 7, 11%) occurred with ENBD.


CONCLUSIONS
Preoperative single ENBD in the future remnant lobe is effective treatment for B-C type I-III hilar cholangiocarcinoma. Preoperative ENBD was rarely complicated with segmental cholangitis.
Arakura
Norikazu
N
Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Matsumoto, Nagano, 390-8621, Japan. arakuran@shinshu-u.ac.jp
Takayama
Mari
M
Ozaki
Yayoi
Y
Maruyama
Masafumi
M
Chou
Yoshimi
Y
Kodama
Ryou
R
Ochi
Yasuhide
Y
Hamano
Hideaki
H
Nakata
Takenari
T
Kajikawa
Shouji
S
Tanaka
Eiji
E
Kawa
Shigeyuki
S
D000368:Aged; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome