A comparative study of 4 F r versus 6 F r nasobiliary drainage catheters: A randomized, controlled trial

Background and Aim Despite the benefits of endoscopic nasobiliary drainage ( NBD ) in endoscopic retrograde cholangiopancreatography ( ERCP ), post‐ ERCP pancreatitis ( PEP ) and nose/throat discomfort can result. We aimed to determine whether the use of a smaller catheter alleviates these complications. Method A randomized, controlled trial at a tertiary care center compared 4 F r and 6 F r NBD catheters; 165 ERCP patients with naïve papillae were randomly assigned to a catheter‐size group. Results The prevalence of PEP was significantly lower in the 4 F r group (3.7%; 3/82) than in the 6 F r group (15.7%; 13/83; P  = 0.019). No spontaneous catheter displacement occurred within 24 h. Discomfort visual analog scores were 2.6 and 4.3 in the 4 F r and 6 F r groups, respectively ( P  = 0.0048) on procedure day; on the following day, the scores were 2.3 and 3.6 ( P  = 0.028). Bile output was 16.3  mL /h and 21.4  mL /h in the 4 F r and 6 F r groups ( P  = 0.051). On obstructive jaundice subgroup analysis, bile drainage was 19.2  mL /h and 22.1  mL /h in the 4 F r and 6 F r groups ( P  = 0.40). The 4 F r group required 5.6 days to reduce bilirubin levels versus 6.1 days in the 6 F r group ( P  = 0.51). Conclusions In patients with naïve papillae, lower rates of PEP and less nose/throat discomfort are associated with the use of 4 F r NBD catheters. In patients with obstructive jaundice, 4 F r and 6 F r catheters are comparable with regard to bile output and bilirubin level reduction.