2003 Volume 23 Issue 7 Pages 1053-1059
Obstructive jaundice occurs in relatively mild disease and severe disease such as acute obstructive suppurative cholangitis. Since the mortality of severe cholangitis is very high, we studied approaches such as emergency biliary-tract drainage case by case. The 1 general approaches to alleviate jaundice are percutaneous transhepatic biliary drainage (PTBD) which is percutaneous transhepatic, and endoscopic nasal biliary drainage (ENBD), which is through the papilla of Vater. The choice depends on the case. We conventionally used PTBD as the treatment of choice for obstructive jaundice. With the introduction of stable endoscopy in May 1988, however, we began using biliary-tract drainage with 5Fr ENBD without using endoscopic sphincterotomy (EST), particularly for obstructive jaundice due to incarcerated common bile duct stones. The approach with 5Fr ENBD in obstructive jaundice due to choledocholithiasis incarceration is nearly as effective as PTBD, and is safe and not associated with serious complications. Since drain insertion for ENBD is difficult in some cases, however drainage should be determined case by case.
