THE BENEFITS OF ENDOSCOPIC NASOBILIARY DRAINAGE WITHOUT SPHINCTEROTOMY FOR ACUTE CHOLANGITIS

Objective: Endoscopic nasobiliary drainage for acute cholangitis is pe rformed with or without endoscopic sphincterotomy. However, sphinctero tomy carries a small but important risk of complications. We evaluated the benefits of endoscopic nasobiliary drainage without sphincterotom y for acute cholangitis, Methods: A total of 166 patients underwent en doscopic nasobiliary drainage with sphincterotomy (73 patients, sphinc terotomy group) or without (93 patients, nonsphincterotomy group). The indications were acute cholangitis due to choledocholithiasis (120 pa tients) or benign (10 patients) or malignant (36 patients) biliary str icture. Patient backgrounds were similar in the two groups. The outcom es of nasobiliary drainage were compared between the groups. Results: Nasobiliary drainage was successful in 69 patients (95%) in the sphinc terotomy group and in 89 (96%) in the nonsphincterotomy group. Efficie nt drainage was achieved in 67 patients (92%) in the sphincterotomy gr oup and in 87 (94%) in the nonsphincterotomy group. Procedure-related complications developed in eight sphincterotomy-group patients (hemorr hage in three, acute cholecystitis in three, acute pancreatitis in one , catheter withdrawal in one) and in two nonsphincterotomy patients (p ancreatitis in one, catheter withdrawal in one) (11% vs 2%; p < 0.05), There were no deaths. Conclusions: Endoscopic nasobiliary drainage wi thout endoscopic sphincterotomy is a simple, safe, and effective treat ment for acute cholangitis. This procedure is especially useful for cr itically ill patients and those with coagulopathy. (C) 1998 by Am. Col l. of Gastroenterology.