Safety and feasibility of omitting routine endoscopic nasobiliary drainage after ERCP for common bile duct stones: a prospective comparative study.

BACKGROUND: The necessity of endoscopic nasobiliary drainage (ENBD) after endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stones remains controversial. This study aimed to evaluate the safety of an ENBD-free strategy and identify criteria for its safe omission. METHODS: In this prospective study, 70 patients undergoing ERCP for common bile duct stones were analyzed. Patients were managed with or without routine ENBD and further stratified according to the use of rectal diclofenac. Clinical outcomes, laboratory parameters, and ERCP-related complications were compared between groups. Logistic regression analyses were performed to identify independent risk factors for complications, with particular focus on patients managed without ENBD. RESULTS: Incidences of procedure-related complications, including post-ERCP pancreatitis (10.3% vs. 9.8%; P = 0.936), hyperamylasemia, and other adverse events, were comparable between the ENBD and no-ENBD groups (all P > 0.05). Similarly, no significant disparities were observed in laboratory markers or recovery metrics, including pain scores, time to symptom relief, and length of hospital stay (all P > 0.05). Within the No-ENBD cohort, multivariable analysis identified the number of cannulation attempts as the only variable remaining statistically significan of complications, with ≥ 2 attempts significantly increasing risk (OR: 18.67; 95% CI: 2.35–148.41; P < 0.001). While rectal diclofenac was confirmed as a safe adjunct, its incremental efficacy was not statistically significant in this study population. CONCLUSION: Routine ENBD placement can be safely omitted in most patients undergoing ERCP with an uncomplicated procedural course. However, ENBD remains an essential protective measure for cases of difficult cannulation to mitigate postoperative risks. TRIAL REGISTRATION: Researchregistry11066. Retrospectively registered.