Initial experience of transnasal endoscopic biliary drainage without conscious sedation for the treatment of acute cholangitis (with video)

BackgroundEndoscopic biliary drainage has been established as providing effective treatment for acute obstructive jaundice and cholangitis. A recently developed ultrathin transnasal videoendoscope is less invasive, even for patients who were critically ill, and can be performed without conscious sedation.ObjectiveTo evaluate the clinical efficacy and safety of biliary drainage (BD) by using transnasal videoendoscopy (TNE) without conscious sedation.DesignCase series.SettingThis procedure was performed at Tokyo Medical University Hospital.PatientsThree patients with bile-duct stones and acute cholangitis and with a previous biliary endoscopic sphincterotomy (ES) were included in this study.InterventionAll patients underwent BD by using a front-viewing TNE. Two 5F stents were placed into the bile duct across the major papilla.Main Outcome MeasurementThe efficacy and safety of the TNE technique.ResultsTransnasal insertion of a TNE endoscope was feasible in all patients, without epistaxis. TNE BD was achieved in all patients. Abdominal pain, fever, and jaundice improved 24 hours after the procedure in all patients. Despite the absence of intravenous conscious sedation, all patients would agree to undergo the procedure again, if necessary.LimitationsManeuverability of the TNE endoscope; limited to patients with a previous ES.ConclusionsIn this small series, unsedated TNE can be used to successfully drain the biliary system in patients with a previous ES. Additional studies to validate this hypothesis are needed.