Abstract
Endoscopic transpapillary treatment such as EST and implantation of stents is presumed to be difficult, when placement of an endoscopic nasal biliary drainage (ENBD) tube is attained after much effort. Therefore, we tried to approach the biliary tract, using the ENBD tube which has been already placed as a guide. Thirty two patients with obstructive jaundice, in whom the placement of an ENBD tube was difficult and also endoscopic transpapillary treatment after palliation of jaundice was needed, were chosen for this trial. Firstly, a ENBD tube was inserted into to the oral cavity through the nose. Secondly, the ENBD tube was inserted into a channel from the tip of fiberscope. Subsequently, the fiberscope was manipulated along the ENBD tube with similar technique as an ordinary ERCP procedure. When performing this method, the following aspects should be given special attention ; constantly watch the tip of the fiberscope from the patient's throat to the duodenal papilla in order to straighten the ENBD tube under X-ray control. This method was successfully performed in 30 of 32 patients. Furthermore, it took less than 5 minuts in all cases to approach the biliary tract. It is concluded that this method of approaching the biliary tract using the ENBD tube which has been already placed as a guide is extremely useful, when the endoscopic transpapillary treatment is thought to be difficult.
