title: Preoperative internal biliary drainage increases the risk of bile juice infection and pancreatic fistula after pancreatoduodenectomy: a prospective observational study.
abstract: OBJECTIVE
  The objective of this study was to identify the most appropriate endoscopic biliary drainage method in patients with pancreatic head cancer.
  
  
  METHODS
  A prospectively collected database comprising 122 consecutive patients who underwent pancreatoduodenectomy, including 72 patients treated by endoscopic retrograde biliary drainage (ERBD) and 50 patients treated by endoscopic nasobiliary drainage (ENBD) procedures, was analyzed.
  
  
  RESULTS
  All bile cultures collected intraoperatively were positive in the ERBD group, and the positive rates of drainage fluid cultures on postoperative days 1, 3, and 5 and the incidence of postoperative abdominal abscess formation were significantly higher than those in the ENBD group. Moreover, ERBD was identified as an independent predictive factor for postoperative pancreatic fistula (POPF) formation (hazards ratio, 11.81; P < 0.001). The receiver operating characteristic curve analysis for the preoperative drainage period in the ERBD group revealed that the determined cutoff level for the onset of POPF was 29 days.
  
  
  CONCLUSIONS
  Endoscopic retrograde biliary drainage resulted in more frequent postoperative complications, including POPF, compared with ENBD. Postoperative pancreatic fistula is more likely to occur if the ERBD period exceeds 1 month in patients scheduled to undergo pancreatoduodenectomy.
authors.affiliation: From the Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Fujii
authors.forename: Suguru
authors.initials: S
authors.lastname: Yamada
authors.forename: Masaya
authors.initials: M
authors.lastname: Suenaga
authors.forename: Mitsuro
authors.initials: M
authors.lastname: Kanda
authors.forename: Hideki
authors.initials: H
authors.lastname: Takami
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sugimoto
authors.forename: Shuji
authors.initials: S
authors.lastname: Nomoto
authors.forename: Akimasa
authors.initials: A
authors.lastname: Nakao
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodera
mesh_terms: D018784:Abdominal Abscess / Q000175:diagnosis / Q000382:microbiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001646:Bile / Q000382:microbiology*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D004322:Drainage / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome