Journal
JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY
Volume 16, Issue 4, Pages 473-477Publisher
SPRINGER TOKYO
DOI: 10.1007/s00534-009-0076-8
Keywords
Hilar cholangiocarcinoma; Preoperative biliary drainage; Endoscopic biliary drainage; Endoscopic nasobiliary drainage; Endoscopic biliary stenting
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Although percutaneous transhepatic biliary drainage has previously been recommended as a primary preoperative step, endoscopic nasobiliary drainage (ENBD) is prevalent as an alternative procedure. Few reports assess the efficacy and safety of ENBD in a substantial patient cohort. Of 116 patients with hilar cholangiocarcinoma who underwent surgery, 62 (43 men and 19 women, median age 69 years) underwent preoperative ENBD. After classification of lesions according to Bismuth-Corlette (B-C) criteria, we evaluated efficacy and safety with respect to B-C type. Patients were classified as B-C types I (n = 5), II (n = 21), IIIa (n = 23), IIIb (n = 5), and IV (n = 8). Preoperative single ENBD was effective in 46/62 patients (74%) including 5/5 (100%) B-C type I, 20/21 (94%) type II, 16/23 (70%) type IIIa, 4/5 (80%) type IIIb, and 1/8 (13%) type IV. Sixteen cases (26%) required additional drainages with ENBD or endoscopic biliary stenting (EBS) in 8/16 (50%), and with PTBD in 8/16 (50%). Mild acute pancreatitis (n = 1, 2%), segmental cholangitis (n = 2, 3%), and acute cholangitis with catheter obstruction (n = 7, 11%) occurred with ENBD. Preoperative single ENBD in the future remnant lobe is effective treatment for B-C type I-III hilar cholangiocarcimona. Preoperative ENBD was rarely complicated with segmental cholangitis.
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