Preoperative endoscopic nasobiliary drainage in 164 consecutive patients with suspected perihilar cholangiocarcinoma: a retrospective study of efficacy and risk factors related to complications.
OBJECTIVE
To assess the clinical benefits of preoperative endoscopic nasobiliary drainage (ENBD) in patients with perihilar cholangiocarcinoma.


BACKGROUND
The advantages of ENBD have been previously reported. However, no studies to date have examined a large number of patients, including those with Bismuth-Corlette (B-C) type III to IV tumors. In addition, sufficient data on the risk factors associated with ENBD complications are not available.


METHODS
This study involved 164 consecutive patients with suspected perihilar cholangiocarcinoma (128 patients with B-C type III-IV tumors) who had undergone unilateral ENBD between January 2007 and December 2010. The success and efficacy of this procedure and the risk factors for post-ENBD cholangitis and pancreatitis were retrospectively evaluated.


RESULTS
The ENBD procedure was successful in 153 (93.3%) of the 164 patients. Of these 164 patients, 65 had serum total bilirubin (TB) levels of 2.0 mg/dL or more before the drainage. The first unilateral ENBD was successfully performed in 60 of the 65 patients, and the TB level decreased to less than 2.0 mg/dL after ENBD in 50 of these 60 patients (83.3%). The significant predictive factors for ENBD efficacy included the pre-ENBD TB level (P = 0.032; 95% confidence interval [CI], 1.01-1.23) and post-ENBD cholangitis (P = 0.012; 95% CI, 1.61-43.2). Post-ENBD cholangitis occurred in 47 (28.8%) of the 163 patients, and a previous endoscopic sphincterotomy (EST) was found to be a significant risk factor for post-ENBD cholangitis (P = 0.008; 95% CI, 1.30-5.46). Post-ENBD pancreatitis occurred in 33 (20.1%) of the 164 patients (26 grade 1 patients, 4 grade 2 patients, and 3 grade 3 patients). The significant risk factors included undergoing pancreatography (P < 0.001; 95% CI, 2.44-31.1) and the absence of previous EBS or ENBD (P < 0.001; 95% CI, 3.03-29.2).


CONCLUSIONS
Unilateral ENBD of the future remnant lobe(s) exhibited a high success rate, suggesting that it is an effective and suitable preoperative drainage method for perihilar cholangiocarcinoma even in patients with B-C type III to IV tumors. To reduce the postprocedural complications, ENBD should be performed without EST or pancreatography.
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Hiroki
H
Kawashima
Akihiro
A
Itoh
Eizaburo
E
Ohno
Yuya
Y
Itoh
Tomoki
T
Ebata
Masato
M
Nagino
Hidemi
H
Goto
Yoshiki
Y
Hirooka
D000368:Aged; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000209:etiology; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010195:Pancreatitis / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors