Is it necessary to insert a nasobiliary drainage tube routinely after endoscopic clearance of the common bile duct in patients with choledocholithiasis-induced cholangitis? A prospective, randomized trial
Received 7 April 2009; accepted 7 August 2009. published online 16 November 2009.
Background
Little is known about whether a routinely inserted endoscopic nasobiliary drainage (ENBD) tube improves the clinical course in patients with choledocholithiasis-induced acute cholangitis after clearance of choledocholithiasis.
Objective
The aim of this study was to investigate the need for ENBD on the clinical outcomes of patients with acute cholangitis undergoing endoscopic clearance of common bile duct (CBD) stones.
Design
Prospective, randomized study.
Setting
Tertiary referral center.
Patients
A total of 104 patients with choledocholithiasis-induced acute cholangitis who underwent primary endoscopic treatment were compared according to insertion of an ENBD tube (51 in the ENBD group and 53 in the no-ENBD group).
Intervention
Insertion of an ENBD tube after clearance of CBD stones.
Main Outcome Measurements
Recurrence of cholangitis and length of hospital stay after clearance of CBD stones.
Results
Baseline clinical characteristics were similar between both groups. There were no significant differences in the recurrence rate of cholangitis at 24 weeks (3.9% for the ENBD group vs 3.8% for the no-ENBD group at 24 weeks; P = .99) and length of hospital stay (7.9 days [standard error = 1.2] for the ENBD group vs 7.9 days [standard error = 0.7] for the no-ENBD group; P = .98). However, procedure time was longer (26.2 [SE = 1.8] minutes vs 22.7 [SE = 1.0] minutes, respectively; P = .01) and the discomfort score was higher (4.9 [SE = 0.4] vs 2.8 [SE = 0.3], respectively; P = .02) in the ENBD group than in the no-ENBD group.
Limitations
Single-center study.
Conclusions
A routinely inserted ENBD tube did not improve the clinical course, despite patients having to endure increased procedure time and discomfort, and the insertion would therefore be unnecessary.
Current affiliations: Department of Internal Medicine (J.K.L., B.K.K., J.H.K., M.-S.K., C.-H.Y., J.L.H.), Dongguk University International Hospital, Dongguk University College of Medicine, Goyang, Gyeonggi-do, Korea, Department of Internal Medicine (S.H.L.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
Reprint requests: Sang Hyub Lee, MD, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do, Korea 463-707.
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr. Lee at gidoctor@snubh.org.
ABSTRACT