Urgent endoscopic nasobiliary drainage without fluoroscopic guidance: a useful treatment for critically ill patients with biliary obstruction

Background: Endoscopic nasobiliary drainage (ENBD) is routinely performed u nder fluoroscopic control,This is a report of our experience with urgent EN BD without fluoroscopic guidance in critically ill patients. Methods: Twenty-six critically ill patients who underwent urgent ENBD for b iliary obstruction were analyzed. ENBD was performed without fluoroscopic c ontrol because of high risk of transportation or inaccessibility of the x-r ay facilities, A pig-tailed nasobiliary catheter was inserted into the bile duct with the help of a guidewire under endoscopic control to bypass the s ite of obstruction, Successful placement was confirmed by free flow of bile on aspiration via the nasobiliary catheter. Results: A nasobiliary catheter was successfully placed in 23 patients (88% ). Adequate bile drainage was achieved in 20 patients with an overall succe ss rate of 77%. There were no procedure-related complications. The mortalit y rate for patients with successful biliary drainage was 10% (2 of 20), in contrast to 83% (5 of 6) for the group in which drainage was unsuccessful. Conclusions: Urgent ENBD is effective for patients with biliary obstruction . With experience, this procedure may be successfully performed in critical ly ill patients without fluoroscopic guidance at primary care hospitals or intensive care units where fluoroscopic facilities are not readily availabl e.