Endoscopic Biliary Drainage without Endoscopic Sphincterotomy

Abstract:Endoscopic biliary drainage (EBD) is usually performed after endoscopic sphincterotomy (EST). In some patients, however, EBD without EST, so‐called nonEST‐EBD, is also effective.Thirty‐four patients treated from 1983 to the present, were investigated to estimate the usefulness, safety, and drawbacks of nonEST‐EBD.First, the reasons for adopting nonEST‐EBD were reviewed in each patient. The most common reason was to reduce jaundice so as to preserve the function of the papilla of Vater in patients with choledocholithiasis who were to undergo surgery. However, such patients were treated in the early period of the investigation, and most would have undergone EST just after endoscopic retrograde cholangiography (ERC), had they been treated more recently. The most important reason, at present, was, thus, to avoid bleeding in patients with general or local hemorrhagic diathesis, who accounted for 20.6% (7/34 of our subjects).Next, the effect of drainage was examined. Drainage in seven patients was judged to be excellent, while that in 15 patients was determined to be effective. In 10 patients without jaundice, nonEST‐EBD was performed to prevent jaundice. Therefore, in 91.7% of patients (22/24), nonEST‐EBD was considered to be useful.Changes in the serum amylase level were investigated to estimate the safety of nonEST‐EBD. Twenty‐seven patients with nonEST‐EBD, in whom the serum amylase level was within normal limits before treatment, and 57 patients with EBD after EST were evaluated. No statistically significant difference was recognized between these two groups in the degree of serum amylase elevation after drainage.NonEST‐EBD is concluded to be an effective and safe method of reducing jaundice, if appropriate patients are selected.