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Efficacy of preoperative endoscopic nasobiliary drainage for hilar cholangiocarcinoma
Author(s) -
Arakura Norikazu,
Takayama Mari,
Ozaki Yayoi,
Maruyama Masafumi,
Chou Yoshimi,
Kodama Ryou,
Ochi Yasuhide,
Hamano Hideaki,
Nakata Takenari,
Kajikawa Shouji,
Tanaka Eiji,
Kawa Shigeyuki
Publication year - 2009
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s00534-009-0076-8
Subject(s) - medicine , biliary drainage , surgery , acute pancreatitis , percutaneous , gastroenterology
Background/Purpose Although percutaneous transhepatic biliary drainage has previously been recommended as a primary preoperative step, endoscopic nasobiliary drainage (ENBD) is prevalent as an alternative procedure. Few reports assess the efficacy and safety of ENBD in a substantial patient cohort. Methods Of 116 patients with hilar cholangiocarcinoma who underwent surgery, 62 (43 men and 19 women, median age 69 years) underwent preoperative ENBD. After classification of lesions according to Bismuth–Corlette (B–C) criteria, we evaluated efficacy and safety with respect to B–C type. Results Patients were classified as B–C types I ( n = 5), II ( n = 21), IIIa ( n = 23), IIIb ( n = 5), and IV ( n = 8). Preoperative single ENBD was effective in 46/62 patients (74%) including 5/5 (100%) B–C type I, 20/21 (94%) type II, 16/23 (70%) type IIIa, 4/5 (80%) type IIIb, and 1/8 (13%) type IV. Sixteen cases (26%) required additional drainages with ENBD or endoscopic biliary stenting (EBS) in 8/16 (50%), and with PTBD in 8/16 (50%). Mild acute pancreatitis ( n = 1, 2%), segmental cholangitis ( n = 2, 3%), and acute cholangitis with catheter obstruction ( n = 7, 11%) occurred with ENBD. Conclusions Preoperative single ENBD in the future remnant lobe is effective treatment for B–C type I–III hilar cholangiocarcimona. Preoperative ENBD was rarely complicated with segmental cholangitis.