title: Efficacy of preoperative endoscopic nasobiliary drainage for hilar cholangiocarcinoma.
abstract: 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.
authors.affiliation: Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Matsumoto, Nagano, 390-8621, Japan. arakuran@shinshu-u.ac.jp
authors.forename: Norikazu
authors.initials: N
authors.lastname: Arakura
authors.forename: Mari
authors.initials: M
authors.lastname: Takayama
authors.forename: Yayoi
authors.initials: Y
authors.lastname: Ozaki
authors.forename: Masafumi
authors.initials: M
authors.lastname: Maruyama
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Chou
authors.forename: Ryou
authors.initials: R
authors.lastname: Kodama
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Ochi
authors.forename: Hideaki
authors.initials: H
authors.lastname: Hamano
authors.forename: Takenari
authors.initials: T
authors.lastname: Nakata
authors.forename: Shouji
authors.initials: S
authors.lastname: Kajikawa
authors.forename: Eiji
authors.initials: E
authors.lastname: Tanaka
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Kawa
mesh_terms: 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