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Background: Endoscopic retrograde biliary drainage (ERBD) using a plastic stent is suggested to be as effective as endoscopic nasobiliary drainage (ENBD) with a nasobiliary catheter for temporary biliary drainage in acute obstructive cholangitis. However, there are few studies that have compared the two methods. We therefore compared the safety and effectiveness of endoscopic biliary decompression by nasobiliary catheter versus plastic stent placement in these patients., Methods: A total of 94 screened patients with acute obstructive cholangitis were randomised to undergo emergency endoscopic biliary drainage with ENBD (n = 47) or ERBD (n = 47). Clinical outcomes and adverse events were compared., Results: Patient backgrounds were similar in the two groups. Endoscopic biliary drainage was successfully achieved in all patients. Eleven patients underwent unscheduled endoscopic retrograde cholangiopancreatography (ERCP) to replace the nasobiliary catheter, 10 due to a catheter (1 in the ENBD group) or stent (9 in the ERBD group) blockage and 1 due to catheter migration. Clinical manifestations were similar, however, there was a significantly lower patient discomfort score in the ERBD group (p <0.05). The mean serum gamma-glutamyltransferase and total bilirubin concentrations after ERCP were significantly higher in the ERBD than ENBD group (p <0.001). Complication rates were similar in the ENBD and ERBD groups. However, the incidence rate of blockage in ERBD was statistically higher than ENBD (p = 0.015)., Conclusions: Endoscopic biliary decompression is an effective treatment for patients with acute obstructive cholangitis. In contrast to other studies, we found an increased rate of blockage in the ERBD group and a greater decrease in liver enzyme levels in the ENBD group.

Objective: To evaluate whether patients with malignant biliary obstruction (MBO) benefit from balloon dilation before the placement of a self‐expanding metal stent (SEMS) for palliative biliary drainage. Methods: Consecutive patients who underwent endoscopic retrograde cholangiopancreatography with SEMS placement for palliative management of MBO were retrospectively included. Comparative analyses of serum bilirubin levels, post‐procedural adverse events, stent patency time, stent dysfunction, and patient survival were performed between the dilation and non‐dilation groups. Results: A total of 221 patients underwent palliative endoscopic SEMS implantation for MBO from January 2014 to June 2018. Dilation significantly improved the percentage of serum bilirubin improvement (37.0% vs 14.3%, P = 0.001), with a decreasing trend in the incidence of post‐procedural cholangitis (2.5% vs 7.8%, P = 0.075), while the rates of other complications such as pancreatitis and bleeding were not increased. The patency time of SEMS and patient survival did not significantly differ between patients with and without dilation. Patients had endoscopic nasobiliary drainage (ENBD) but not dilation showed similar short‐term outcomes as patients underwent dilation but without ENBD. Conclusions: Dilation with a small‐caliber balloon catheter before the placement of SEMS is a safe and effective approach for MBO. Balloon dilation may improve the short‐term efficacy of SEMS placement, while long‐term outcomes are not obviously affected. The short‐term effect of stricture dilation may be achieved by ENBD. Further studies are needed to confirm our results. [ABSTRACT FROM AUTHOR]

Objective To investigate the success and recurrence rates and factors influencing the effect of endoscopic therapy for patients with biliary stricture after orthotopic liver transplantation ( OLT). Methods Data of 56 patients who underwent endoscopic therapy for biliary stricture after OLT from 2006 to 2009 were reviewed in this study. Their clinical data, laboratory parameters and endoscopic features were recorded. Results Biliary stricture was treated successfully in 47 patients (83.9%). Compared with those with treatment failure, there was a longer duration from OLT to initial presentations ( P = 0.02) in the successful group, fewer endoscopic retrograde cholangiopancreatography ( ERCP) treatments ( P < 0.01) and fewer stents inserted per patient ( P < 0.01). Multivariate analysis showed that the number of ERCP treatments per patient was negatively related with treatment success. Of the 47 patients successfully treated, stricture recurred in 13 (27.7%) during follow-up. Compared with those without recurrence, the recurrence group had a shorter initial presentation time after OLT, higher serum alanine aminotransferase, aspartate aminotransferase and γ-glutamyltransferase levels, higher numbers of ERCP treatments and stents used and a longer duration of treatment ( P < 0.01 for all). Multivariate analysis showed that the treatment duration was a risk factor for recurrence ( OR 2.33, 95% CI 1.34-4.05, P < 0.01). Conclusions Endoscopic treatment is a safe and effective modality for biliary stricture after OLT. The number of ERCP treatments per patient is negatively related with treatment success and long treatment duration was a risk factor for stricture recurrence. [ABSTRACT FROM AUTHOR]