Abstract
Endoscopic retrograde biliary drainage(ERBD)has been widely adopted as an excellent therapeutic modality for biliary drainage in patients with malignant obstruction of thebiliary tract. A major disadvantage of this procedure is an obstruction of the drainagetube, which requires the replacement of the drainage tube every 3-4 months. To preventthe obstruction of the drainage tube an endoprosthesis with a larger diameter (14Fr.)has recently been on the market, but the insertion of this tube requires a large-diameter duodenal fiberscope (TJF-M20, Olympus)and is technically very difficult. We describe here a new method for the insertion of the 14Fr. ERBD tube. In this method, endoscopic transnasal biliary drainage (ENBD) with a 7.2Fr. ENBD tube was performed after endoscapic sphincterotomy. Several days later, a 14Fr. ERBD endeprnsthesis was inserted utilizing the previously inserted 7.2Fr. ENBD tube as a guiding catheter. This methodcould reduce the technical difficulty of the 14Fr. tube insertion and may prolong the period of the effective biliary drainage.
