Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2017; 23(29): 5386-5394
Published online Aug 7, 2017. doi: 10.3748/wjg.v23.i29.5386
Outcomes of preoperative endoscopic nasobiliary drainage and endoscopic retrograde biliary drainage for malignant distal biliary obstruction prior to pancreaticoduodenectomy
Guo-Qiang Zhang, Yong Li, Yu-Ping Ren, Nan-Tao Fu, Hai-Bing Chen, Jun-Wu Yang, Wei-Dong Xiao
Guo-Qiang Zhang, Yong Li, Yu-Ping Ren, Nan-Tao Fu, Hai-Bing Chen, Jun-Wu Yang, Wei-Dong Xiao, Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Zhang GQ and Li Y designed the research; Zhang GQ analyzed the data and drafted the article; Li Y interpreted the data, revised the article and finally approved the version of the manuscript; Ren YP, Fu NT, Chen HB and Yang JW collected the data; Xiao WD assisted in drafting the article; all authors had approved the article to be published.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the First Affiliated Hospital of Nanchang University, Nanchang, China.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yong Li, MD, Professor, Department of General Surgery, the First Affiliated Hospital of Nanchang University, No. 17, Yongwai Zhengjie, Nanchang 330006, Jiangxi Province, China. yfyly@163.com
Telephone: +86-791-88694131 Fax: +86-791-8869413
Received: March 20, 2017
Peer-review started: March 23, 2017
First decision: April 21, 2017
Revised: May 3, 2017
Accepted: June 19, 2017
Article in press: June 19, 2017
Published online: August 7, 2017
Abstract
AIM

To compare the outcomes of preoperative endoscopic nasobiliary drainage (ENBD) and endoscopic retrograde biliary drainage (ERBD) in patients with malignant distal biliary obstruction prior to pancreaticoduodenectomy (PD).

METHODS

Data from 153 consecutive patients who underwent preoperative endoscopic biliary drainage prior to PD between January 2009 and July 2016 were analyzed. We compared the clinical data, procedure-related complications of endoscopic biliary drainage (EBD) and postoperative complications of PD between the ENBD and ERBD groups. Univariate and multivariate analyses with odds ratios (ORs) and 95% confidence intervals (95%CIs) were used to identify the risk factors for deep abdominal infection after PD.

RESULTS

One hundred and two (66.7%) patients underwent ENBD, and 51 (33.3%) patients underwent ERBD. Endoscopic sphincterotomy was less frequently performed in the ENBD group than in the ERBD group (P = 0.039); the EBD duration in the ENBD group was shorter than that in the ERBD group (P = 0.036). After EBD, the levels of total bilirubin (TB) and alanine aminotransferase (ALT) were obviously decreased in both groups, and the decreases of TB and ALT in the ERBD group were greater than those in the ENBD group (P = 0.004 and P = 0.000, respectively). However, the rate of EBD procedure-related cholangitis was significantly higher in the ERBD group than in the ENBD group (P = 0.007). The postoperative complications of PD as graded by the Clavien-Dindo classification system were not significantly different between the two groups (P = 0.864). However, the incidence of deep abdominal infection after PD was significantly lower in the ENBD group than in the ERBD group (P = 0.019). Male gender (OR = 3.92; 95%CI: 1.63-9.47; P = 0.002), soft pancreas texture (OR = 3.60; 95%CI: 1.37-9.49; P = 0.009), length of biliary stricture (≥ 1.5 cm) (OR = 5.20; 95%CI: 2.23-12.16; P = 0.000) and ERBD method (OR = 4.08; 95%CI: 1.69-9.87; P = 0.002) were independent risk factors for deep abdominal infection after PD.

CONCLUSION

ENBD is an optimal method for patients with malignant distal biliary obstruction prior to PD. ERBD is superior to ENBD in terms of patient tolerance and the effect of biliary drainage but is associated with an increased risk of EBD procedure-related cholangitis and deep abdominal infection after PD.

Keywords: Preoperative endoscopic biliary drainage, Endoscopic nasobiliary drainage, Endoscopic retrograde biliary drainage, Pancreaticoduodenectomy, Malignant distal biliary obstruction

Core tip: To compare the outcomes of preoperative endoscopic biliary drainage via endoscopic nasobiliary drainage (ENBD) and endoscopic retrograde biliary drainage (ERBD) in patients with malignant distal biliary obstruction prior to pancreaticoduodenectomy (PD), we studied 153 patients with malignant distal biliary obstruction who underwent ENBD or ERBD prior to PD. ERBD was superior to ENBD in terms of patient tolerance and the effect of biliary drainage, but the incidence rates of endoscopic biliary drainage procedure-related complications and deep abdominal infection after PD were higher than those associated with ENBD. Multivariate analysis showed that ERBD was an independent risk factor for deep abdominal infection after PD. ENBD is the optimal method for patients with malignant distal biliary obstruction prior to PD.