Comparison of Clinical Outcomes Between Endoscopic Nasobiliary Drainage and Biliary Stenting in Single-Stage Triple-Endoscopic Combined Therapy for Gallbladder and Common Bile Duct Stones

Abstract Introduction: The management of gallbladder stones combined with common bile duct stones (CBDS) remains a clinical challenge. While laparoscopic cholecystectomy (LC) with endoscopic retrograde cholangiopancreatography (ERCP) is widely adopted, the optimal intraoperative biliary drainage strategy during single-stage triple-endoscopic (laparoscopic, choledochoscopic, and duodenoscopic) combined therapy is unclear. This study compared the clinical outcomes of endoscopic nasobiliary drainage (ENBD) versus endoscopic retrograde biliary drainage (ERBD) within this advanced framework. Methods: A retrospective cohort study was conducted on 82 patients who underwent single-stage triple-endoscopic combined therapy at two centers between January 2022 and November 2025. Patients were categorized into ENBD (n=47) and ERBD (n=35) groups. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. Primary outcomes included overall complication rates (Clavien-Dindo classification), operative blood loss, postoperative length of stay (LOS), total LOS, and hospitalization costs. Results: After IPTW adjustment, baseline covariates were well-balanced. The ERBD group exhibited a significantly higher overall complication rate compared to the ENBD group (83.8% vs. 57.9%, P=0.020). Weighted multivariable logistic regression confirmed ERBD as an independent risk factor for overall complications (adjusted OR=5.83, 95% CI: 1.22–27.75, P=0.027). No significant differences were observed in operative blood loss, postoperative LOS, total LOS, or total hospitalization costs between the two groups. Conclusion: In patients undergoing single-stage triple-endoscopic combined therapy for gallbladder stones with CBDS, ENBD is associated with a significantly lower risk of postoperative overall complications compared to ERBD. Although both drainage methods result in similar postoperative recovery times and hospitalization costs, ENBD appears to be a safer short-term biliary drainage option within this advanced surgical framework. We recommend individualized selection of the drainage method based on the patient’s specific risk profile.