Initial experience of transnasal endoscopic biliary drainage without conscious sedation for the treatment of acute cholangitis (with video).

BACKGROUND

Endoscopic biliary drainage has been established as providing effective treatment for acute obstructive jaundice and cholangitis. A recently developed ultrathin transnasal videoendoscope is less invasive, even for patients who were critically ill, and can be performed without conscious sedation.

OBJECTIVE

To evaluate the clinical efficacy and safety of biliary drainage (BD) by using transnasal videoendoscopy (TNE) without conscious sedation.

DESIGN

Case series.

SETTING

This procedure was performed at Tokyo Medical University Hospital.

PATIENTS: Three patients with bile-duct stones and acute cholangitis and with a previous biliary endoscopic sphincterotomy (ES) were included in this study.

INTERVENTION: All patients underwent BD by using a front-viewing TNE. Two 5F stents were placed into the bile duct across the major papilla.

MAIN OUTCOME MEASUREMENT: The efficacy and safety of the TNE technique.

RESULTS

Transnasal insertion of a TNE endoscope was feasible in all patients, without epistaxis. TNE BD was achieved in all patients. Abdominal pain, fever, and jaundice improved 24 hours after the procedure in all patients. Despite the absence of intravenous conscious sedation, all patients would agree to undergo the procedure again, if necessary.

LIMITATIONS: Maneuverability of the TNE endoscope; limited to patients with a previous ES.

CONCLUSIONS

In this small series, unsedated TNE can be used to successfully drain the biliary system in patients with a previous ES. Additional studies to validate this hypothesis are needed.