Abstract
Purpose: We investigated whether endoscopic nasobiliary drainage (ENBD) is superior to endoscopic biliary stenting (EBS) in pancreaticoduodenectomy (PD) patients. Subjects and Methods: The outcomes of ENBD and EBS were compared in 97 subjects who underwent PD. (Comparison 1) Comparison of the interval to jaundice reduction and the proportion of subjects requiring additional treatment based on the method of the primary drainage (ENBD or EBS). (Comparison 2) Comparison of the incidences of postoperative complications (surgical site infection, pancreatic fistula, etc.) between the groups treated by ENBD and EBS. Results: (Comparison 1) In those with jaundice only, with total serum bilirubin levels of ≥5 mg/dL, ENBD and EBS were performed in 49 and 25 subjects, respectively. The mean interval until jaundice reduction was 12.8 days （median 9 days） in the ENBD group and 18.1 days （median 18 days） in the EBS group (p=0.036, 0.049). Additional treatment was needed in 2 patients of the ENBD group (4.1%) due to natural deviation, and 18 patients of the EBS group (72.0%) due to cholangitis or poor jaundice reduction (p＜0.01). (Comparison 2) The numbers of subjects who underwent ENBD and EBS just before surgery were 56 and 39, respectively, including those requiring tube placement due to severe pancreatic ductal stenosis despite having a serum bilirubin level of ＜5 mg/dL. The incidences of postoperative surgical site infection, pancreatic fistula and infectious complications were 23.2, 17.9 and 39.3% in the ENBD group, and 20.5, 15.4 and 33.3% in the EBS group, respectively (N. S.). Discussion and Conclusions：As for the postoperative complications, no significant differences were was observed between the two groups treated by ENBD and EBS just before surgery. However, as to the interval to jaundice reduction or the necessity of additional treatment, the results were superior in the ENBD as compared to those in the EBS group. Our results suggest that ENBD is superior to EBS for primary jaundice reduction before PD.
