title: Preoperative drainage for distal biliary obstruction: endoscopic stenting or nasobiliary drainage?
abstract: OBJECTIVE
  Few studies have compared endoscopic biliary stenting and endoscopic nasobiliary drainage for preoperative biliary drainage in patients with malignant distal biliary obstruction. We aimed to evaluate their safety and efficacy in such patients awaiting pancreaticoduodenectomy.
  
  
  METHODS
  Seventy-six of 80 patients (40 with pancreatic cancer, 26 with distal bile duct cancer, and 14 with ampullary cancer) who underwent endoscopic preoperative biliary drainage were included, and we evaluated whether endoscopic biliary stenting or endoscopic nasobiliary drainage provided a safer and more effective drainage for patients awaiting pancreaticoduodenectomy. We also determined whether the type of cancer influenced tube dysfunction.
  
  
  RESULTS
  No significant differences in the overall rate of catheter-related complications, the rate of tube dysfunction, or the median interval from preoperative biliary drainage to the time of tube dysfunction were observed between the two groups. Tube dysfunction was observed significantly more frequently in patients with pancreatic cancer than in those with distal bile duct or ampullary cancer.
  
  
  CONCLUSIONS
  Both endoscopic biliary stenting and endoscopic nasobiliary drainage provided safe and effective drainage for patients awaiting pancreaticoduodenectomy. Tube dysfunction was associated with preoperative biliary drainage significantly earlier in patients with pancreatic cancer than in those with distal bile duct cancer or ampullary cancer.
authors.affiliation: Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Japan. sugi1.1220@gmail.com
authors.forename: Harutoshi
authors.initials: H
authors.lastname: Sugiyama
authors.forename: Toshio
authors.initials: T
authors.lastname: Tsuyuguchi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Sakai
authors.forename: Takao
authors.initials: T
authors.lastname: Nisikawa
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokosuka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000601:surgery*; D002779:Cholestasis / Q000401:mortality / Q000628:therapy*; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D012307:Risk Factors; D015607:Stents