Clin Endosc.  2015 Nov;48(6):542-548. 10.5946/ce.2015.48.6.542.

The Clinical Usefulness of Simultaneous Placement of Double Endoscopic Nasobiliary Biliary Drainage

• Kim HJ
• Lee SK
• Ryu CH
• Park DH
• Lee SS
• Seo DW
• Kim MH

• KMID: 2380413
• DOI: http://doi.org/10.5946/ce.2015.48.6.542

Abstract

BACKGROUND/AIMS
To evaluate the technical feasibility and clinical efficacy of double endoscopic nasobiliary drainage (ENBD) as a new method of draining multiple bile duct obstructions.
METHODS
A total of 38 patients who underwent double ENBD between January 2004 and February 2010 at the Asan Medical Center were retrospectively analyzed. We evaluated indications, laboratory results, and the clinical course.
RESULTS
Of the 38 patients who underwent double ENBD, 20 (52.6%) had Klatskin tumors, 12 (31.6%) had hepatocellular carcinoma, 3 (7.9%) had strictures at the anastomotic site following liver transplantation, and 3 (7.9%) had acute cholecystitis combined with cholangitis. Double ENBD was performed to relieve multiple biliary obstruction in 21 patients (55.1%), drain contrast agent filled during endoscopic retrograde cholangiopancreatography in 4 (10.5%), obtain cholangiography in 4 (10.5%), drain hemobilia in 3 (7.9%), relieve Mirizzi syndrome with cholangitis in 3 (7.9%), and relieve jaundice in 3 (7.9%).
CONCLUSIONS
Double ENBD may be useful in patients with multiple biliary obstructions.

Keyword

Biliary stricture; Endoscopic nasobiliary drainage; Cholangiopancreatography, endoscopic retrograde; Klatskin's tumor; Double endoscopic nasobiliary drainage

MeSH Terms

Carcinoma, Hepatocellular
Cholangiography
Cholangiopancreatography, Endoscopic Retrograde
Cholangitis
Cholecystitis, Acute
Cholestasis
Chungcheongnam-do
Constriction, Pathologic
Drainage*
Hemobilia
Humans
Jaundice
Klatskin's Tumor
Liver Transplantation
Mirizzi Syndrome
Retrospective Studies

Figure

• 

  Fig. 1. Double endoscopic nasobiliary drainage (ENBD) in a patient with hilar cholangiocarcinoma (Bismuth classifi cation II). Unintended contrast fi lling and high-grade biliary obstruction with separated intrahepatic ducts (IHDs) were noted and contrast drainage was not accomplished during ERCP (A, E). After two guidewires were inserted in the two IHDs (B, C, F and G), the scope was extracted under fluoroscopic guidance, with a double ENBD tube deployed in both IHDs (D, H).

• 

  Fig. 2. Images from a patient with Mirizzi syndrome treated with simultaneous endoscopic nasobiliary drainage (ENBD) and endoscopic naso-gallbladder drainage with a double ENBD catheter. The endoscopic retrograde cholangiopancreatography catheter was inserted further through a bile duct for deep cannulation into the cystic duct (A), following by insertion of a guidewire and its direction toward the cystic duct (B). Pus discharge thorough the opening of bile duct was noted during cannulation (E, F). A second guidewire was inserted into the right intrahepatic duct (IHD) and the ENBD catheters were passed along the guidewires (C, G). Finally, the scope was withdrawn with double ENBD catheters placed in the cystic duct and right IHD (D, H).

• 

  Fig. 3. Passage of two endoscopic nasobiliary drainage catheters through the same nostril.

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