title: Endoscopic nasobiliary drainage is the most suitable preoperative biliary drainage method in the management of patients with hilar cholangiocarcinoma.
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.
authors.affiliation: Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan. hiropon@med.hokudai.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawakami
authors.forename: Masaki
authors.initials: M
authors.lastname: Kuwatani
authors.forename: Manabu
authors.initials: M
authors.lastname: Onodera
authors.forename: Shin
authors.initials: S
authors.lastname: Haba
authors.forename: Kazunori
authors.initials: K
authors.lastname: Eto
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ehira
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yamato
authors.forename: Taiki
authors.initials: T
authors.lastname: Kudo
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tanaka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kondo
authors.forename: Masahiro
authors.initials: M
authors.lastname: Asaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001659:Biliary Tract; D001663:Bilirubin / Q000097:blood; D018281:Cholangiocarcinoma / Q000601:surgery / Q000628:therapy*; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D008113:Liver Neoplasms / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D018084:Ultrasonography, Interventional / Q000009:adverse effects*
chemical_list: D001663:Bilirubin