Endoscopic naso-biliary drainage for the management of common bile duct obstruction
Chen, C.J.; Yang, K.C.; Kao, C.R.; Chou, S.Y.
Journal of the Formosan Medical Association 87(8): 796-801
1988
ISSN/ISBN: 0371-7682 PMID: 3241158 Document Number: 319345
Acute suppurative cholangnitis is a severe clinical condition that occurs when infection supervenes in an obstructed common bile duct. The mortality rate is high in patients requiring urgent surgical treatment. From May 1986 to February 1987, 14 patients with acute cholangitis and obstructive jaundice were treated by endoscope drainage and decompression of the common bile duct using naso-biliary tubes at Mackay Memorial Hospital. They were 8 men and 6 women, varying in age from 33 to 93 years with a mean age at 63 years. In 13 patients, acute cholangitis was due to gallstone obstruction in the common bile duct. The remaining one was a case of stenosis of the common bile duct caused by chronic inflammation of the pancreatic head. Many of them were extremely sick and had other serious medical problems; 4 had cardiopulmonary disease, 4 had clinical evidence of sepsis, 3 had diabetes mellitus and 2 complicated with acute pancreatitis. By using a French-5 catheter, endoscopic sphincterotomy was not necessary for insertion of the naso-biliary drains. In most of these cases, symptoms and signs of obstructive cholangitis were relieved rapidly after insertion of the drainage tube and suction of pus in the obstructed common bile duct. There was no suffering of pain after the procedure. Fever subsided within 36 hours and abnormal laboratory values (leukocytosis, bilirubin, GPT) resumed to normal within a few days. All of the drains have functioned well without further complications and mortality. After adequate drainage of obstructive jaundice, all but one aged patient with severe cardiac disease received surgical management (11 cases) or underwent endoscopic sphincterotomy with stone extraction (2 cases). From our preliminary experiences we suggest that the nonsurgical approach of endoscopic naso-biliary drainage should be considered as the first option in the management of patients with common bile duct obstruction and acute cholangitis.