Outcomes of preoperative endoscopic nasobiliary drainage and endoscopic retrograde biliary drainage for malignant distal biliary obstruction prior to pancreaticoduodenectomy

Table 1 Demographic and clinical characteristics of patients who underwent endoscopic biliary drainage (endoscopic nasobiliary drainage and endoscopic retrograde biliary drainage) prior to pancreaticoduodenectomy n (%)

Variable	ENBD (n = 102)	ERBD (n = 51)	P value
Age (yr)	55.26 ± 9.07	56.24 ± 9.65	0.542
Gender (Male)	58 (56.9)	29 (56.9)	1.000
Concomitant diseases
Hypertension	9 (8.8)	5 (9.8)	0.843
Cardiac disease	16 (15.7)	6 (11.8)	0.515
Diabetes mellitus	22 (21.6)	13 (25.5)	0.586
Anemia	39 (38.2)	24 (47.1)	0.296
Hypoproteinemia	31 (30.4)	20 (39.2)	0.275
Acute pancreatitis	6 (5.9)	4 (7.8)	0.732
Acute cholangitis	7 (6.9)	7 (13.7)	0.233
Malignant disease			0.307
Papilla adenocarcinoma	70 (68.7)	41(80.4)
Distal cholangiocarcinoma	19 (18.6)	6 (11.8)
Pancreatic carcinoma	13 (12.7)	4 (7.8)
ALT at admission (IU/L)	189.16 ± 161.52	158.41 ± 132.25	0.241
TB at admission (µmol/L)	198.92 ± 85.57	205.45 ± 93.69	0.667
Data of EBD
EST	48 (47.1)	33 (64.7)	0.039
Length of biliary stricture (cm)	1.55 ± 0.84	1.58 ± 0.83	0.849
EBD duration (d)	11.05 ± 4.87	13.55 ± 7.60	0.036
Data of PD
Operative time (min)	358.97 ± 84.21	375.49 ± 105.66	0.334
Intraoperative bleeding (mL)	475.49 ± 274.47	488.04 ± 306.31	0.798
Blood transfusion	45 (44.1)	21 (41.2)	0.729
Pancreas texture (soft)	56 (54.9)	22 (43.1)	0.170
Diameter of pancreatic duct (mm)	3.35 ± 1.29	3.48 ± 1.29	0.567
Diameter of common bile duct (cm)	1.73 ± 0.45	1.78 ± 0.52	0.540
Total hospital stay (d)	31.85 ± 10.35	29.84 ± 10.03	0.254
Postoperative hospital stay (d)	18.50 ± 9.50	16.80 ± 8.21	0.278
Total expenditure (USD)	10093 ± 3229	10100 ± 2779	0.988

EBD: Endoscopic biliary drainage; ENBD: Endoscopic nasobiliary drainage; EST: Endoscopic sphincterotomy; ERBD: Endoscopic retrograde biliary drainage; PD: Pancreaticoduodenectomy.

Table 2 Changes in bilirubin and transaminase in patients who underwent endoscopic nasobiliary drainage or endoscopic retrograde biliary drainage prior to pancreaticoduodenectomy

Variable	ENBD	ERBD	P value
TB at admission (μmol/L)	198.92 ± 85.57	205.45 ± 93.69	0.667
ALT at admission (IU/L)	189.16 ± 161.52	158.41 ± 132.25	0.241
TB at 1 d before PD (µmol/L)	96.45 ± 74.90	66.01 ± 52.85	0.004
ALT at 1 d before PD (IU/L)	72.63 ± 50.66	49.73 ± 28.11	0.000
TB at discharge (μmol/L)	42.16 ± 42.57	28.45 ± 25.25	0.014
ALT at discharge (IU/L)	35.49 ± 22.65	34.74 ± 34.29	0.872

ENBD: Endoscopic nasobiliary drainage; ERBD: Endoscopic retrograde biliary drainage; PD: Pancreaticoduodenectomy; TB: Total bilirubin; ALT: Alanine aminotransferase.

Table 3 Procedure-related complications of endoscopic biliary drainage and the postoperative complications of pancreaticoduodenectomy between the two groups n (%)

Variable	ENBD (n = 102)	ERBD (n = 51)	P value
Complications of EBD
EBD dysfunction	16 (15.7)	5 (9.8)	0.319
Adverse events after EBD
Pancreatitis	12 (11.8)	12 (23.5)	0.059
Cholangitis	8 (7.8)	12 (23.5)	0.007
Others	3 (2.9)	2 (3.9)	1.000
Complications of PD
Pancreatic fistula	34 (33.3)	21 (41.2)	0.350
Grade A	14 (13.7)	13 (25.5)
Grade B	16 (15.7)	7 (13.7)
Grade C	4 (3.9)	1 (2.0)
Delayed gastric emptying	25 (23.6)	12 (23.5)	0.893
Grade A + B	14(12.8)	7 (13.7)
Grade C	11 (10.8)	5 (9.8)
PPH	7 (6.9)	5 (9.8)	0.523
Grade A + B	6 (5.9)	3 (5.9)
Grade C	1 (1.0)	2 (3.9)
Biliary fistula	2 (2.0)	1 (2.0)	1.000
Deep abdominal infection	25 (24.5)	22 (43.1)	0.019
Wound infection	17 (16.7)	10 (19.6)	0.653
Pulmonary infection	11 (10.8)	8 (15.7)	0.386
Reoperation	2 (2.0)	1 (2.0)	1.000
Perioperative death	5 (4.9)	3 (5.9)	1.000
Complication	60 (58.8)	34 (66.7)	0.864
Grade I-II	39 (38.2)	21 (41.2)
Grade III	13 (12.8)	9 (17.6)
Grade IV-V	8 (7.8)	4 (7.9)

EBD: Endoscopic biliary drainage; ENBD: Endoscopic nasobiliary drainage; PPH: Postpancreatectomy hemorrhage; ERBD: Endoscopic retrograde biliary drainage; PD: Pancreaticoduodenectomy.

Table 4 Univariate and multivariate analyses of the risk factors for deep abdominal infection after pancreaticoduodenectomy

Variable	Univariate		Multivariate
	OR (95%CI)	P value	OR (95%CI)	P value
Age (≥ 57 yr)	0.99 (0.48-2.02)	0.970
Gender (Male)	2.27 (1.09-4.72)	0.028	3.92 (1.63-9.47)	0.002
Hypertension	0.89 (0.27-3.01)	0.855
Cardiac disease	1.06 (0.40-2.80)	0.904
Diabetes mellitus	1.72 (0.78-3.77)	0.178
Anemia	0.65 (0.32-1.32)	0.234
Hypoproteinemia	1.05 (0.51-2.17)	0.901
Acute pancreatitis	1.55 (0.42-5.77)	0.513
Acute cholangitis	1.28 (0.41-4.06)	0.671
Malignant disease (pancreatic carcinoma)	0.60 (0.21-1.67)	0.325
TB at admission (≥ 200 µmol/L)	0.85 (0.43-1.71)	0.652
ALT at admission (≥ 200 IU/L)	1.91 (0.87-4.17)	0.106
ERBD method	2.34 (1.14-4.77)	0.020	4.08 (1.69-9.87)	0.002
EST	0.90 (0.45-1.78)	0.757
Length of biliary stricture (≥ 1.5 cm)	3.89 (1.86-8.14)	0.000	5.20 (2.23-12.16)	0.000
EBD duration (≥ 12 d)	0.91 (0.45-1.80)	0.777
Operative time (≥ 380 min)	0.72 (0.36-1.43)	0.347
Intraoperative bleeding (≥ 600 mL)	0.66 (0.31-1.40)	0.278
Blood transfusion	0.85 (0.42-1.71)	0.652
Pancreas texture (soft)	3.20 (1.53-6.66)	0.002	3.60 (1.37-9.49)	0.009
Diameter of pancreatic duct (≤ 3 mm)	2.11 (1.01-4.38)	0.046	1.60 (0.59-4.31)	0.354
Diameter of common bile duct (> 1.5 cm)	1.52 (0.76-3.04)	0.237

EST: Endoscopic sphincterotomy; EBD: Endoscopic biliary drainage; ERBD: Endoscopic retrograde biliary drainage; TB: Total bilirubin; ALT: Alanine aminotransferase.