Experience with endoscopic biliary drainage in Singapore.

In several overseas centres endoscopic biliary drainage is now a standard procedure in the initial or definitive management of biliary tract obstruction. We report the first nine patients in whom this procedure was carried out in our unit. Four patients presented with acute cholangitis due to cholelithiasis. Urgent endoscopic biliary drainage improved the general condition in three patients prior to subsequent elective surgery. In one other patient with huge common bile duct calculi a biliary stent prevented recurrent episodes of cholangitis. Endoscopic endoprostheses were used in three patients with malignant biliary tract obstruction. Two had terminal metastatic disease and endoscopic drainage provided adequate palliation of jaundice and pruritus in one. Endoprosthesis blockage necessitated percutaneous drainage in the other patient. The third patient with carcinoma of the head of the pancreas was improved by endoscopic drainage prior to an open surgical bypass procedure. Another patient with obstructive jaundice due to terminal gall bladder carcinoma experienced relief of jaundice and pruritus following endoscopic insertion of a nasobiliary drain. We anticipate that endoscopic biliary drainage will become increasingly used in Singapore.