Efficacy and safety of 1-step transnasal endoscopic nasobiliary drainage for the treatment of acute cholangitis in patients with previous endoscopic sphincterotomy (with videos)

Background Endoscopic nasobiliary drainage (NBD) for the treatment of acute cholangitis is an accepted method. A recently developed ultrathin transnasal videoendoscope is minimally invasive, even for patients who are critically ill. Objective To evaluate the clinical efficacy and safety of 1-step NBD by transnasal videoendoscopy (TNE). Design Prospective case study. Setting This study was performed at Tokyo Medical University Hospital. Patients Twenty patients with acute cholangitis who had previously undergone an endoscopic sphincterotomy (ES); including 10 with bile-duct stones, 8 with pancreatic cancers, 1 with chronic pancreatitis, and 1 with benign biliary stricture, were enrolled in this study. An indwelling self-expandable metallic stent (SEMS) was placed in all patients with pancreatic cancers. Intervention All patients underwent NBD via front-viewing TNE. A 5F NBD catheter was placed into the bile duct. Main Outcome Measurement The efficacy and safety of this technique. Results The transnasal insertion of TNE was feasible in all patients, and none had epistaxis. Abdominal pain, fever, and jaundice were improved at 24 hours after the procedure in the majority of patients. The mean procedural time was 18.1 minutes. One patient pulled out the NBD catheter. None of the patients died. TNE-NBD was achieved in 19 patients (95%). Limitations Maneuverability of the TNE, limited to patients with a previous ES or the placement of an SEMS. Conclusions NBD that uses TNE may be a useful and novel technique for the treatment of acute cholangitis in patients with previous ES.