Bridge of preoperative biliary drainage is a useful management for patients undergoing pancreaticoduodenectomy

Background/Objectives: The aims of this study were to clarify the effect of preoperative biliary drainage (PBD) on postoperative outcomes and the role of preoperative intentional exchange from endoscopic nasobiliary drainage (ENBD) to endoscopic retrograde biliary drainage (ERBD) for patients waiting to undergo pancreaticoduodenectomy (PD). Methods: We evaluated the effect of PBD and intentional exchange of PBD on the perioperative variables in 292 patients. Results: A total of 179 (61.3%) of 292 patients received PBD. There was no marked difference in the postoperative outcomes between the patients who did and did not receive PBD. Among the 160 patients who initially received endoscopic PBD, 10 (6.3%) underwent stent exchange for stent dysfunction, 59 (36.9%) who did not develop stent dysfunction underwent intentional stent exchange from ENBD to ERBD (bridge PBD group), and 91 (56.9%) did not receive any stent exchange (unchanged PBD group). The bridge PBD group had a longer duration of PBD (37 days) (p <0.001) and a shorter preoperative hospital stay after PBD (32 days) (p <0.001) than the unchanged PBD group (25 and 46 days, respectively); however, there were no significant differences in the postoperative variables. The incidence of stent exchange due to stent dysfunction in the bridge PBD group (11.9%) was lower than that in patients who initially received ERBD (36.0%) (p = 0.015). Conclusions: Bridge PBD worked well for extending the duration of PBD without worsening the postoperative outcomes after PD. (C) 2019 IAP and EPC. Published by Elsevier B.V. All rights reserved.