Experiences with the Long Standing Nasobiliary Tube in Biliary Diseases

Abstract

Specially designed longstanding nasobiliary tubes allow to reflect upon some well established therapeutic rules. The safe, decompressing effect of the tube leads to prompt relief of obstructive suppurative cholangitis. Therefore emergency of laparotomy can be avoided in high risk patients. Large common bile duct stones until now have required a large papillotomy with increased frequency of complications. The attempt to dissolve those stones with Capmul is justified on an account of a 50% success rate. Either a very small EPT or even non is necessary in order to insert the tube.

A Comparative Study on the Efficacy of Covered Metal Stent and Plastic Stent in Unresectable Malignant Biliary Obstruction

“…Given the fact that a stent of 7 Fr or more is physiologically sufficient to induce biliary drainage,21 this lack of difference in the early efficacy of drainage between the plastic stent group and the Hanaro covered SEMS group in our study may come from using 10 Fr plastic stents. The time to biliary stent occlusion of a 10 Fr plastic stent has been reported average 134 to 164 days 22,23. Davids et al7 reported stent patency of 273 days for metal stent (Wallstent; Schneider, Minneapolis, MN, USA) and 126 days for polyethylene plastic stent in distal malignant biliary obstruction.…”

Palliative treatment of obstructive jaundice by transpapillary introduction of large bore bile duct endoprosthesis.

“…A biliary fistula often remains, when the permanent positioning of a percutaneous prosthesis fails. [1][2][3][4][5][6][7][8][9][10][11][12] It was logical to expect that an endoscopic technique should be developed for introduction of biliary endoprostheses through the natural orifice of the papilla and the natural common duct channel, thereby avoiding the main disadvantage of the percutaneous approach. Up to the present it has only been possible to introduce 2.1 mm diameter endoprostheses and, in our experience, these endoprostheses do not always guarantee an unimpeded bile flow.…”

Duodenoscopic Transpapillary Techniques and Results in Biliary and Pancreatic Diseases: An Update

“…In addition, the tube can be irrigated with solutions to help expel stones. Solvents such as monooctanoin can be perfused via the N-B tube to shrink large stones and facilitate passage [56][57][58]. Nasobiliary drainage is especially valuable for temporary drainage of obstruction due to benign or malignant bile duct lesions.…”