Su1365 Endoscopic Nasobiliary Drainage; Complications and Long-Term Outcomes

Endoscopic Nasobiliary Drainage; Complications and Long-Term Outcomes Kazumichi Kawakubo*, Hiroshi Kawakami, Masaki Kuwatani, Shin Haba, Taiki Kudo, Yoko Abe, Naoya Sakamoto Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan Background: Endoscopic nasobiliary drainage (ENBD) is well established procedure for the management pancreatobiliary diseases. However, complications and long-term outcomes were not well known. The aim of this study was to evaluate the complications and long-term outcomes of ENBD. Materials And Methods: We retrospectively reviewed the prospective ERCP database about ENBD at Hokkaido University Hospital between April 2010 and November 2012. Complications were defined as any complications after ENBD. Long-term outcomes were analyzed by stent dysfunction rate and time to stent dysfunction. Stent dysfunction was defined as ENBD occlusion and/or spontaneous dislocation requiring reintervention. Time to stent dysfunction was calculated by Kaplan-Meier method. Results: During the study periods, 204 patients (median age 69, 138 male and 66 female) underwent 298 ENBD. Median procedure time was 38 min. The number of ENBD was one in 233, two in 58 and three in 7. Distal and hilar malignant obstruction was 64 and 135 respectively, while the remaining 99 were benign diseases. Complications were observed in 56 (19%); 20 post-ERCP pancreatitis, 18 cholangitis, 5 accidental removal, 4 retroperitoneal perforation, 3 post-EST bleeding, 3 cholecystitis, 1 ENBD-induced ulcer, 1 cystic duct perforation and 1 portobiliary fistula. ENBD as an iinitial drainage was significantly associated with complications (Odds ratio 3.1 [95% C.I. 1.7-5.7]). Stent dysfunction occurred in 47 (16%). The causes of stent dysfunction were as follows; 24 spontaneous dislocation and 23 ENBD occlusion. Time to stent dysfunction did not reach median, and mean time was 16.4 days (9.3-23.5). ENBD as a non-initial drainage was a significant risk factor for stent dysfunction (Hazard radio 2.4 [1.1-6.2]). Conclusion: Post-ERCP pancreatitis and cholangitis was the most frequently encountered complications after ENBD. ENBD as initial drainage was a significant risk factor for complications, but had better stent patency than did those as non-initial drainage.