Nasobiliary drainage following endoscopic sphincterotomy. A useful method of preventing and treating early complications.

The authors analyze a retrospective study of 850 patients who underwent endoscopic sphincterotomy (ES). One group of patients (705) routinely had nasobiliary drainage following ES as a prophylactic measure to prevent complications, while 145 patients were not drained. Complications, mortality and the need for emergency surgery were compared in both groups. In the drained group, the complication rate was 2% vs 10.3% in the nondrained group (P less than 0.001), and mortality was 0.4% vs 2.7% (P = 0.03). Emergency surgery was required in 0.1% in the drained patients versus 3.4% in the nondrained group (P = 0.01). Based on these data within the limits of a retrospective study, the authors strongly support the routine use of nasobiliary drainage to prevent complications, which usually occur within the first 24 h, and also to facilitate the immediate treatment of the complications. This procedure is also highly recommended when ES is performed by inexperienced endoscopists and with a technically demanding ES, which is frequently followed by complications.