Is nasobiliary drainage unnecessary for drainage of acute suppurative cholangitis? Our experience

Two randomized controlled trials comparing endoscopic nasobiliary drainage (ENBD) and internal endoscopic biliary drainage (internal EBD) for acute suppurative cholangitis (ASC) showed no significant difference in efficacy and both preferred internal EBD to ENBD. In this study, the necessity of ENBD was re-examined. Over five years, 59 patients underwent an emergency endoscopic procedure for ASC in our institute. If drainage was needed, we selected internal EBD as a first choice and ENBD was used in patients predicted to have early obstruction of the tube or retrograde infection of the bile duct. The rate of ENBD, for which reason ENBD was selected, and the efficacy of drainage were examined retrospectively. In the 59 patients, 40 patients had the stones completely removed without drainage, five internal EBD and two ENBD were performed without removal of stones and five internal EBD and seven ENBD were performed after removal of stones. In terms of white blood cell count and direct bilirubin level, no significant difference was observed between ENBD and internal EBD patients. ENBD was mainly selected for the patients with multiple biliary strictures, hemorrhage tendency and excessive purulent bile. Even though internal drainage is suitable in many ASC patients, ENBD is necessary in selected patients.