EFFECT OF ENDOSCOPIC NASOBILIARY DRAINAGE ON MALIGNANT OBSTRUCTIVE JAUNDICE

Abstract

It has been known that percutaneous transhepatic cholangiodrainage (PTCD) is an effective way of biliary drainage on obstructive jaundice. In recent papers, it has been shown that endoscopic nasobiliary drainage (ENBD) is an effective way of drainage on not only benign but also malignant obstructive jaundice. The purpose of this study is to clarify the effect of ENBD comparing with that of PTCD on malignant obstructive jaundice. ENBD were performed in 5 cases of cancer of the papilla of Vater and PTCD were performed in 35 cases of malignant obstructive jaundice (bile duct cancer: 16 cases, cancer in the head of pancreas: 12 cases, cancer of the papilla of Vater: 7 cases). Results were as followed, Daily mean bile volume discharged from drainage tube were 439±117.8 ml in ENBD and 433.6 + 40.1 ml in PTCD. Durations of drainage were 9 to 23 days (mean 14.2 days) in EN BD and 2 to 69 days (mean 24.7 days) in PTCD. Effects of drainage were estimated by decreases of serum total bilirubin. In ENBD, serum total bilirubin were 9.78±3.0 mg/dl (M±SE) at drainage, 7.09±2.2 mg/dl at 3days after drainage and 5.17±1.6 mg/dl at 7 days after drainage. In PTCD, serum total bilirubin were 13.7±1.9 mg/dl at drainage, 11.06±1.1 mg/dl at 3 days after drainage and 8.44±1.09 mg/dl at 7 days after drainage. Decrease of serum total bilirubin were satisfactory in both ENBD and PTCD. Complication of ENBD was obstruction of the drainage tube in one case, while complications of PTCD were hemobilia in 3 cases and one of them developed renal failure. In ENBD restriction of body movement of patients was not necessary during drainage, though restricted for several days in PTCD. We could shorten the durations of drainage and proceed to other examinations necessary for the operation immediately after drainage by ENBD. We think EN BD is an effective treatment of biliary drainage on malignant obstructive jaundice, especially on cancer of the papilla of Vater.