A team from Hong Kong, China, compared the efficacy of nasobiliary catheter and indwelling stent as temporary measures for biliary decompression in acute suppurative cholangitis caused by bile duct stones.
Over a 60-month period, 79 patients with acute cholangitis who required emergent endoscopic drainage were recruited to the trial.
Indications for urgent drainage included any one of the following: temperature greater than 39°C, septic shock with systolic blood pressure less than 90 mm Hg, increasing abdominal pain, and impaired level of consciousness.
Some 5 patients, who had previously undergone sphincterotomy or had coexisting intrahepatic duct stones, were excluded.
After successful bile duct cannulation, patients were randomized to receive either a nasobiliary catheter (NBC group, n = 40) or indwelling stent (stent group, n = 34) without sphincterotomy for biliary decompression.
| Less post-procedure discomfort with the indwelling stent.
| Gastrointestinal Endoscopy |
The researchers measured procedure time, complications, clinical response, and patient discomfort (scored with a 10-cm, unscaled visual analog score).
All procedures were successful in the NBC group; there was 1 failure in the stent group.
The mean procedure time was similar in both groups (NBC group 14.0 min vs stent group 11.4 min).
There were 2 ERCP-related complications in the NBC group.
Furthermore, 4 patients pulled out the nasobiliary catheter and 1 catheter became kinked.
One stent occluded.
The team found that there was a significantly lower mean patient discomfort score on day 1 after the procedure in the stent group (stent group 1.8 vs NBC group 3.9).
The overall mortality rate was 6.8% (2.5% NBC group vs 12% stent group).
Author Danny W. H. Lee, of the Prince of Wales Hospital, Chinese University of Hong Kong, said on behalf of his colleagues, "Endoscopic biliary decompression by nasobiliary catheter or indwelling stent was equally effective for patients with acute suppurative cholangitis caused by bile duct stones."
"The indwelling stent was associated with less post-procedure discomfort and avoided the potential problem of inadvertent removal of the nasobiliary catheter," he concluded.