title: Lower incidence of complications in endoscopic nasobiliary drainage for hilar cholangiocarcinoma.
abstract: OBJECTIVE
  To identify the most effective endoscopic biliary drainage technique for patients with hilar cholangiocarcinoma.
  
  
  METHODS
  In total, 118 patients with hilar cholangiocarcinoma underwent endoscopic management [endoscopic nasobiliary drainage (ENBD) or endoscopic biliary stenting] as a temporary drainage in our institution between 2009 and 2014. We retrospectively evaluated all complications from initial endoscopic drainage to surgery or palliative treatment. The risk factors for biliary reintervention, post-endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis, and percutaneous transhepatic biliary drainage (PTBD) were also analyzed using patient- and procedure-related characteristics. The risk factors for bilateral drainage were examined in a subgroup analysis of patients who underwent initial unilateral drainage.
  
  
  RESULTS
  In total, 137 complications were observed in 92 (78%) patients. Biliary reintervention was required in 83 (70%) patients. ENBD was significantly associated with a low risk of biliary reintervention [odds ratio (OR) = 0.26, 95%CI: 0.08-0.76, P = 0.012]. Post-ERCP pancreatitis was observed in 19 (16%) patients. An absence of endoscopic sphincterotomy was significantly associated with post-ERCP pancreatitis (OR = 3.46, 95%CI: 1.19-10.87, P = 0.023). PTBD was required in 16 (14%) patients, and Bismuth type III or IV cholangiocarcinoma was a significant risk factor (OR = 7.88, 95%CI: 1.33-155.0, P = 0.010). Of 102 patients with initial unilateral drainage, 49 (48%) required bilateral drainage. Endoscopic sphincterotomy (OR = 3.24, 95%CI: 1.27-8.78, P = 0.004) and Bismuth II, III, or IV cholangiocarcinoma (OR = 34.69, 95%CI: 4.88-736.7, P < 0.001) were significant risk factors for bilateral drainage.
  
  
  CONCLUSIONS
  The endoscopic management of hilar cholangiocarcinoma is challenging. ENBD should be selected as a temporary drainage method because of its low risk of complications.
authors.affiliation: Kazumichi Kawakubo, Hiroshi Kawakami, Masaki Kuwatani, Shin Haba, Taiki Kudo, Yoko A Taya, Shuhei Kawahata, Yoshimasa Kubota, Kimitoshi Kubo, Kazunori Eto, Nobuyuki Ehira, Hiroaki Yamato, Manabu Onodera, Naoya Sakamoto, Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo 0608638, Japan.
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Kawakubo
authors.affiliation: Kazumichi Kawakubo, Hiroshi Kawakami, Masaki Kuwatani, Shin Haba, Taiki Kudo, Yoko A Taya, Shuhei Kawahata, Yoshimasa Kubota, Kimitoshi Kubo, Kazunori Eto, Nobuyuki Ehira, Hiroaki Yamato, Manabu Onodera, Naoya Sakamoto, Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo 0608638, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawakami
authors.affiliation: Kazumichi Kawakubo, Hiroshi Kawakami, Masaki Kuwatani, Shin Haba, Taiki Kudo, Yoko A Taya, Shuhei Kawahata, Yoshimasa Kubota, Kimitoshi Kubo, Kazunori Eto, Nobuyuki Ehira, Hiroaki Yamato, Manabu Onodera, Naoya Sakamoto, Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo 0608638, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kuwatani
authors.affiliation: Kazumichi Kawakubo, Hiroshi Kawakami, Masaki Kuwatani, Shin Haba, Taiki Kudo, Yoko A Taya, Shuhei Kawahata, Yoshimasa Kubota, Kimitoshi Kubo, Kazunori Eto, Nobuyuki Ehira, Hiroaki Yamato, Manabu Onodera, Naoya Sakamoto, Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo 0608638, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Haba
authors.affiliation: Kazumichi Kawakubo, Hiroshi Kawakami, Masaki Kuwatani, Shin Haba, Taiki Kudo, Yoko A Taya, Shuhei Kawahata, Yoshimasa Kubota, Kimitoshi Kubo, Kazunori Eto, Nobuyuki Ehira, Hiroaki Yamato, Manabu Onodera, Naoya Sakamoto, Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo 0608638, Japan.
authors.forename: Taiki
authors.initials: T
authors.lastname: Kudo
authors.affiliation: Kazumichi Kawakubo, Hiroshi Kawakami, Masaki Kuwatani, Shin Haba, Taiki Kudo, Yoko A Taya, Shuhei Kawahata, Yoshimasa Kubota, Kimitoshi Kubo, Kazunori Eto, Nobuyuki Ehira, Hiroaki Yamato, Manabu Onodera, Naoya Sakamoto, Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo 0608638, Japan.
authors.forename: Yoko A
authors.initials: YA
authors.lastname: Taya
authors.affiliation: Kazumichi Kawakubo, Hiroshi Kawakami, Masaki Kuwatani, Shin Haba, Taiki Kudo, Yoko A Taya, Shuhei Kawahata, Yoshimasa Kubota, Kimitoshi Kubo, Kazunori Eto, Nobuyuki Ehira, Hiroaki Yamato, Manabu Onodera, Naoya Sakamoto, Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo 0608638, Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Kawahata
authors.affiliation: Kazumichi Kawakubo, Hiroshi Kawakami, Masaki Kuwatani, Shin Haba, Taiki Kudo, Yoko A Taya, Shuhei Kawahata, Yoshimasa Kubota, Kimitoshi Kubo, Kazunori Eto, Nobuyuki Ehira, Hiroaki Yamato, Manabu Onodera, Naoya Sakamoto, Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo 0608638, Japan.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Kubota
authors.affiliation: Kazumichi Kawakubo, Hiroshi Kawakami, Masaki Kuwatani, Shin Haba, Taiki Kudo, Yoko A Taya, Shuhei Kawahata, Yoshimasa Kubota, Kimitoshi Kubo, Kazunori Eto, Nobuyuki Ehira, Hiroaki Yamato, Manabu Onodera, Naoya Sakamoto, Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo 0608638, Japan.
authors.forename: Kimitoshi
authors.initials: K
authors.lastname: Kubo
authors.affiliation: Kazumichi Kawakubo, Hiroshi Kawakami, Masaki Kuwatani, Shin Haba, Taiki Kudo, Yoko A Taya, Shuhei Kawahata, Yoshimasa Kubota, Kimitoshi Kubo, Kazunori Eto, Nobuyuki Ehira, Hiroaki Yamato, Manabu Onodera, Naoya Sakamoto, Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo 0608638, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Eto
authors.affiliation: Kazumichi Kawakubo, Hiroshi Kawakami, Masaki Kuwatani, Shin Haba, Taiki Kudo, Yoko A Taya, Shuhei Kawahata, Yoshimasa Kubota, Kimitoshi Kubo, Kazunori Eto, Nobuyuki Ehira, Hiroaki Yamato, Manabu Onodera, Naoya Sakamoto, Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo 0608638, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ehira
authors.affiliation: Kazumichi Kawakubo, Hiroshi Kawakami, Masaki Kuwatani, Shin Haba, Taiki Kudo, Yoko A Taya, Shuhei Kawahata, Yoshimasa Kubota, Kimitoshi Kubo, Kazunori Eto, Nobuyuki Ehira, Hiroaki Yamato, Manabu Onodera, Naoya Sakamoto, Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo 0608638, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yamato
authors.affiliation: Kazumichi Kawakubo, Hiroshi Kawakami, Masaki Kuwatani, Shin Haba, Taiki Kudo, Yoko A Taya, Shuhei Kawahata, Yoshimasa Kubota, Kimitoshi Kubo, Kazunori Eto, Nobuyuki Ehira, Hiroaki Yamato, Manabu Onodera, Naoya Sakamoto, Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo 0608638, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Onodera
authors.affiliation: Kazumichi Kawakubo, Hiroshi Kawakami, Masaki Kuwatani, Shin Haba, Taiki Kudo, Yoko A Taya, Shuhei Kawahata, Yoshimasa Kubota, Kimitoshi Kubo, Kazunori Eto, Nobuyuki Ehira, Hiroaki Yamato, Manabu Onodera, Naoya Sakamoto, Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo 0608638, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Sakamoto
keywords: Complications; Endoscopic biliary stenting; Endoscopic nasobiliary drainage; Endoscopic sphincterotomy; Hilar cholangiocarcinoma