Conversion of endoscopic nasobiliary drainage into internal drainage versus endoscopic biliary stenting for benign biliary obstruction: a retrospective propensity score-matched comparative study.

BACKGROUND

Endoscopic nasobiliary drainage (ENBD) conversion to internal drainage using scissor forceps is a specialized technique primarily explored in malignant obstructions. This study evaluates its efficacy, radiation safety, and long-term durability in patients with benign biliary obstruction (BBO) compared to conventional endoscopic retrograde biliary drainage (ERBD).

OBJECTIVES

To evaluate the efficacy, radiation safety, and long-term durability of scissor forceps conversion compared to conventional endoscopic retrograde biliary drainage (ERBD) in patients with BBO.

DESIGN

A retrospective comparative study using 1:1 propensity score matching (PSM).

METHODS

We retrospectively analyzed BBO patients who underwent either scissor forceps conversion (Experimental group) or conventional ERBD (Control group) between 2018 and 2025. To ensure rigorous comparison, 1:1 propensity score matching (PSM) was performed, balancing baseline characteristics including age, etiology, and inflammatory markers. Primary endpoints were dose area product (DAP), fluoroscopy time, and long-term stent patency.

RESULTS

After 1:1 matching (n = 43 per group), the experimental group demonstrated a significant reduction in radiation exposure and procedural duration. The mean DAP was substantially lower in the experimental group compared to the control group (p < 0.001), alongside a shorter total fluoroscopy time (p < 0.001). Although the early biochemical recovery showed a more favorable downward trend in total bilirubin for the experimental group, the difference was not statistically significant. Perioperative adverse events, including post-ERCP pancreatitis (4.65% vs 2.3%), were comparable, with all cases occurring prior to the conversion maneuver. During the follow-up, the experimental group exhibited a favorable trend toward sustained patency (Median Patency: Not Reached vs 13.0 months; p = 0.419).

CONCLUSION

In BBO management, converting ENBD to internal drainage significantly enhances radiation safety and procedural efficiency without compromising clinical safety or long-term stent durability. This "mini-invasive" approach aligns with the ALARA principle and represents a refined evidence-based strategy for patients requiring cumulative biliary interventions.