Endoscopic nasobiliary drainage (ENBD) [1 1
Figure 1 The scissor forceps developed by the authors were designed to hold the endoscopic
nasobiliary drainage (ENBD) tube at the depressed portion so that the cutting blade
was almost perpendicular to the longitudinal axis of tube when cutting
A patient with bile duct carcinoma complained of severe pharyngeal discomfort after
insertion of the ENBD tube, and the drainage was changed from an external to an internal
one using our procedure. Until the time of the operation, no complications such as
cholangitis, or migration or dislodgment had been seen, and the patient’s quality
of life remained at a high level. The cut end of the tube extracted in the operation
was not sharp and no apparent deformation was seen (Figure [2
Figure 2 The cut end of the extracted tube was not sharp and no apparent deformation was seen
Our procedure is easily applied. On the other hand, however, there is the drawback
of possible complications such as migration, dislodgment or perforation. We thought
that with the use of an α-type tube, migration and dislodgment of the tube would be
prevented because of the loop of the cut tube in the duodenum. We also believe that
there is little risk of perforation of the duodenum by the cut edge of the tube, because
it is unlikely that the tube will be cut at an acute angle.
Although further studies using a larger number of patients are needed, we think that
our procedure is very beneficial to some patients. However, this procedure should
only be used in exceptional situations, as change from a nasobiliary catheter to an
internal stent would be the normal procedure of choice.
