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World J Hepatol. Aug 28, 2015; 7(18): 2171-2176
Published online Aug 28, 2015. doi: 10.4254/wjh.v7.i18.2171
Current status of preoperative drainage for distal biliary obstruction
Harutoshi Sugiyama, Toshio Tsuyuguchi, Yuji Sakai, Rintaro Mikata, Shin Yasui, Yuto Watanabe, Dai Sakamoto, Masato Nakamura, Reina Sasaki, Jun-ichi Senoo, Yuko Kusakabe, Masahiro Hayashi, Osamu Yokosuka
Harutoshi Sugiyama, Toshio Tsuyuguchi, Yuji Sakai, Rintaro Mikata, Shin Yasui, Yuto Watanabe, Dai Sakamoto, Masato Nakamura, Reina Sasaki, Jun-ichi Senoo, Yuko Kusakabe, Masahiro Hayashi, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
Author contributions: Sugiyama H substantially contributed to the study design and writing of the manuscript; Tsuyuguchi T contributed to the critical revision of the manuscript and the approval of the article to be published; Sakai Y contributed to the revision of the manuscript and to the revision of the review; Mikata R, Yasui S, Watanabe Y and Sakamoto D contributed to the revision of the manuscript; Nakamura M, Sasaki R, Senoo J, Kusakabe Y and Hayashi M contributed to the revision of the manuscript and to the revision of the English; Yokosuka O contributed to the final approval of the version of the article to be published.
Conflict-of-interest statement: The authors report no disclosures relevant to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Harutoshi Sugiyama, MD, PhD, Assistant Professor, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba 260-8670, Japan. sugi1.1220@gmail.com
Telephone: +81-43-2262083 Fax: +81-43-2262088
Received: April 28, 2015
Peer-review started: May 5, 2015
First decision: June 25, 2015
Revised: August 9, 2015
Accepted: August 13, 2015
Article in press: August 14, 2015
Published online: August 28, 2015
Processing time: 122 Days and 23.5 Hours
Abstract

Preoperative biliary drainage (PBD) was developed to improve obstructive jaundice, which affects a number of organs and physiological mechanisms in patients waiting for surgery. However, its role in patients who will undergo pancreaticoduodenectomy for biliary obstruction remains controversial. This article aims to review the current status of the use of preoperative drainage for distal biliary obstruction. Relevant articles published from 1980 to 2015 were identified by searching MEDLINE and PubMed using the keywords “PBD”, “pancreaticoduodenectomy”, and “obstructive jaundice”. Additional papers were identified by a manual search of the references from key articles. Current studies have demonstrated that PBD should not be routinely performed because of the postoperative complications. PBD should only be considered in carefully selected patients, particularly in cases where surgery had to be delayed. PBD may be needed in patients with severe jaundice, concomitant cholangitis, or severe malnutrition. The optimal method of biliary drainage has yet to be confirmed. PBD should be performed by endoscopic routes rather than by percutaneous routes to avoid metastatic tumor seeding. Endoscopic stenting or nasobiliary drainage can be selected. Although more expensive, the use of metallic stents remains a viable option to achieve effective drainage without cholangitis and reintervention.

Keywords: Preoperative drainage; Biliary drainage; Distal biliary obstruction; Pancreaticoduodenectomy; Obstructive jaundice

Core tip: Because of the postoperative complications, studies have demonstrated that preoperative biliary drainage (PBD) should not be routinely performed in patients who will undergo pancreaticoduodenectomy. PBD may be selectively applied in patients with severe jaundice, cholangitis, or severe malnutrition and in those patients with a relatively long wait before surgery. PBD should be performed through endoscopic routes rather than percutaneous routes to avoid metastatic tumor seeding. Endoscopic stenting or nasobiliary drainage can be selected. Although more expensive, the use of metallic stents remains a viable option to avoid reinterventions.