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  • Title: The safety and effectiveness of endoscopic biliary decompression by plastic stent placement in acute suppurative cholangitis compared with nasobiliary drainage.
    Author: Park SY, Park CH, Cho SB, Yoon KW, Lee WS, Kim HS, Choi SK, Rew JS.
    Journal: Gastrointest Endosc; 2008 Dec; 68(6):1076-80. PubMed ID: 18635173.
    Abstract:
    BACKGROUND: Endoscopic retrograde biliary drainage (ERBD) by using a plastic stent is suggested to be as effective as endoscopic nasobiliary drainage (ENBD) for temporary biliary drainage in acute suppurative cholangitis (ASC). However, there are few studies that compared ERBD and ENBD in ASC. OBJECTIVES: We compared the safety and efficacy of ERBD and ENBD for temporary biliary drainage in patients with ASC. DESIGN: A case series. SETTING: A tertiary-referral center. PATIENTS AND INTERVENTIONS: Eighty patients with ASC underwent endoscopic biliary drainage with ENBD (n = 41) and ERBD (n = 39). MAIN OUTCOME MEASUREMENT: Clinical outcomes, including complications related to ERCP and complications related to the type of the indwelling catheter. RESULTS: Endoscopic biliary drainage was successfully achieved in all patients (100%). There were no significant differences in the demographic data between the 2 groups. There were no differences in the improvement of clinical and laboratory parameters between the 2 groups. Overall ERCP-related complication rates in the ENBD and ERBD groups were 31.7% and 38.5%, respectively (P = .527). Hyperamylasemia occurred in 18 patients, 12.2% in the ENBD group (5/41) and 33.3% in the ERBD group (13/39) (P = .024). Without endoscopic sphincterotomy (EST), there was no statistically significant difference in the incidence of hyperamylasemia between the 2 groups. However, with an EST, hyperamylasemia was more frequent in the ERBD group (12/28 [42.9%]) than in the ENBD group (3/27 [11.1%]) (P = .008). LIMITATION: A single-center experience. CONCLUSIONS: Endoscopic biliary decompression, whether by ERBD or ENBD, is an effective treatment for patients with ASC. However, more frequent hyperamylasemia with ERBD and EST deserves further evaluation.
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