Endoscopic biliary drainage

Endoscopic drainage of the occluded biliary system through the papilla Vateri consists of two different methods, i.e. bilio- nasal and bilio-duodenal drainage. For bilio-nasal drainage a 250-cm- long preformed polyethylene tube is placed above the stenosis to provide the flow out of the congested bile duct. This external drainage is indicated to prevent the blockade of a ductal stone after endoscopic papillotomy (EPT), to treat septic cholangitis, and to dissolve big ductal stones chemically. Insertion of a bilio-nasal probe succeeds in 95% of hte cases. Internal bilio-duodenal drainage is more difficult and succeeds in 87%, its main indication is the inoperable malignant bile duct obstruction. The value of a preoperative biliary drainage is in discussion. Internal bilio-duodenal drainage will perhaps not prolong the survival time of patients with malignant biliary obstruction but it will improve the life quality in the majority of the patients. The decrease of serum bilirubin after the implantation of the prosthesis and the localization of the tumor are of prognostic significance.