Endoscopic management strategies in relation to the severity of acute cholangitis

Treatment of acute obstructive cholangitis by ENBD and ERBD: Analysis of 56 cases

AIM: To compare the safety and effectiveness of endoscopic nasobiliary drainage (ENBD) versus endoscopic retrograde biliary drainage (ERBD) in patients with acute obstructive cholangitis.

METHODS: Fifty-six selected patients with acute obstructive cholangitis were randomized to undergo emergency endoscopic biliary drainage by ENBD (n = 28) or ERBD (n = 28). Clinical outcomes and adverse events were compared between the two groups.

RESULTS: Baseline patient data were similar between the two groups. Endoscopic biliary drainage was successful in all patients. Complication rates were similar between the ENBD and ERBD groups. There was no significant difference in the incidence of abdominal pain, fever, or jaundice at 12, 24 h, 3 d, and 7 d postoperatively. However, the incidence rate of blockage was statistically higher in the ERBD group than in the ENBD group (P = 0.015).

CONCLUSION: 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 patients undergoing ERBD. If the patient has more purulent bile or poor liver function, ENBD should be used.

Endoscopic nasobiliary drainage with sphincterotomy in acute obstructive cholangitis: a prospective randomized controlled trial

OBJECTIVE

We aimed to determine the efficacy and safety of endoscopic nasobiliary drainage (ENBD) with or without endoscopic sphincterotomy (EST) for temporary biliary decompression in patients with acute obstructive cholangitis.

METHODS

In total, 72 patients with acute obstructive cholangitis were prospectively randomized to undergo emergency ENBD with EST (EST group, n = 36) or without EST (non-EST group, n = 36). The clinical outcomes and complications between the two groups were compared.

RESULTS

Endoscopic nasobiliary decompression was successful in all 72 patients. Four patients underwent a second endoscopic retrograde cholangiopancreatography (ERCP) to replace the nasobiliary catheter due to blockage (one in the EST group and two in the non-EST group) or migration (one in the EST group). The mean serum γ-glutamyltransferase and total bilirubin levels after treatment were significantly higher in the non-EST group than in the EST group (P < 0.05). However, no significant differences were observed for other parameters evaluated. The total complication rate was similar between the two groups (EST 25.0% vs non-EST 19.4%). Although hemorrhage occurred more frequently in the EST group and acute pancreatitis in the non-EST group, these differences were not significant.

CONCLUSIONS

EST is helpful and safe for biliary drainage while ENBD without EST is the first choice for acute cholangitis. EST may increase the efficacy of ENBD in patients with papillary inflammatory stricture and thick bile.