Application of endoscopic nasobiliary cutting in the treatment of hilar cholangiocarcinoma

Objective The aim of the study was to study the clinical efficacy and prognosis of endoscopically cutting the nasobiliary duct and leaving its residual segment as a biliary stent in the treatment of hilar cholangiocarcinoma (HC).Methods The clinical data of 55 patients with HC treated by endoscopic biliary drainage at the Gastrointestinal Endoscopy Center of our hospital (Renmin Hospital of Wuhan University,China) from August 2017 to August 2019 were retrospectively analyzed.According to different drainage schemes,patients were divided into the endoscopic nasobiliary cutting group (n=26) and the endoscopic retrograde biliary drainage (ERBD) group (n=29).The postoperative liver function indexes,incidence of postoperative complications,median patency period of stents,and median survival time of patients were compared between the two groups.Results Liver function indexes (total bilirubin,direct bilirubin,alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,gamma-glutamyl transpeptidase) were significantly decreased in 55 patients a week postoperaticely (P < 0.05),and decreases in liver function indexes in the endoscopic nasobiliary cutting group were more significant than those in the ERBD group (P < 0.05).The incidence of biliary tract infection in the endoscopic nasobiliary cutting group was significantly lower than that in the ERBD group (15.40% vs.41.4%,P < 0.05).In the endoscopic nasobiliary cutting subgroups,there were 1 and 3 cases of biliary tract infection in the gastric antrum cutting group (n=21) and duodenal papilla cutting group (n=5),respectively,and 0 cases and 2 cases of displacement,respectively;there was a statistically significant difference in terms of complications between the two subgroups (P < 0.05).The median patency period (190 days) and median survival time (230 days) in the nasobiliary duct cutting group were higher than those (169 days and 202 days) in the ERBD group,but there was no significant difference (P > 0.05).Conclusion The nasobiliary duct was cut by using endoscopic scissors in Stage II after the bile was fully drained through the nasobiliary duct.The residual segment could still support the bile duct and drain bile.The reduction of jaundice and the recovery of liver enzymes were significant,and the incidence of biliary tract infection was low.Cutting off the nasobiliary duct at the duodenal papilla results in a higher incidence of biliary tract infection,and the residual segment of the nasobiliary duct is more likely to be displaced.Endoscopic nasobiliary-cutting drainage is an effective,simple,and safe method to reduce jaundice in the palliative treatment of HC.