Randomized Controlled Trial of Modified Nasobiliary Fixation and Drainage Technique

Abstract

ObjectivesWe investigated the clinical efficacy of a modified nasobiliary fixation and drainage technique which was designed in an attempt to reduce unplanned extubation and tube blockage and improve bile drainage and the comfort of catheterized patients.MethodsFrom January 2019 to December 2020, 230 patients receiving Endoscopic nasobiliary drainage (ENBD) during hospitalization were recruited to this study. Participants were randomly allocated to 2 groups by using the block randomization method: in the control group: the conventional method of nasobiliary fixation was adopted after surgery; in the test group: intraoperative annular cutting of nasobiliary tubes was performed and the exposed catheter length was standardized. The modified “tube-nose-ear” three-step technique was performed after surgery. The clinical efficacy of a modified nasobiliary fixation and drainage technique was evaluated and compared between the test group and the control group.ResultsThe rate of unplanned extubation and incidence of complications were significantly lower in the test group than the control group. In addition, the rate of bilirubin decrease after drainage was higher in the test group. Patient discomfort during catheterization was also significantly reduced using the modified technique (P < 0.05).ConclusionsThe modified technique of nasobiliary fixation and drainage technique can significantly reduce unplanned extubation and nasobiliary tube blockage after ENBD, facilitate biliary drainage, and improve patient comfort. This technique warrants wider application in clinical practice.

ERCP-related Adverse Events in Pediatric Patients: A 10-Years Single-Site Review

“…The study found that leaving the nasobiliary tube in place did not provide additional clinical bene ts to patients but instead prolonged operation time and increased patient discomfort [18]. Another study showed that using an improved "tube-nose-ear" three-step xation technique signi cantly reduce nausea and vomiting after ENBD, facilitate biliary drainage, and improve patient comfort [19]. For postoperative nausea and vomiting due to anesthetic drugs, Kovac emphasized the importance of multimodal pain management (including preoperative regional anesthesia and reducing the use of opioid drugs) and prophylaxis with combination drug therapy (such as dexamethasone and 5-HT3 receptor antagonists).…”

Pathophysiological consequences and treatment strategy of obstructive jaundice

“…ENBD is a simple and easy approach for relieving biliary obstruction by reducing biliary pressure, thereby rapidly relieving the symptoms of biliary obstruction and controlling biliary infection[ 109 , 110 ]. However, it is important to note that the nasobiliary duct can irritate the throat, is prone to slippage or blockage, and has the disadvantage of removing abundant bile salts, which can further cause disorders of the water-electrolyte balance and digestive dysfunction in patients[ 111 ].…”