Endoscopic nasobiliary drainage is superior to biliary stent placement in preventing postendoscopic papillary balloon dilation pancreatitis.

Background: Endoscopic papillary balloon dilation (EPBD) has been recommended as a potential alternative to endoscopic sphincterotomy for common bile duct stones (CBDS), due to protecting the sphincter function.

Objectives: This retrospective study aims to evaluate the safety and efficacy of endoscopic nasobiliary drainage (ENBD) versus endoscopic retrograde biliary drainage (ERBD) after EPBD for CBDS.

Design: This study is a retrospective analysis of patients with CBDS who underwent EPBD followed by either ENBD or ERBD. It enrolled 283 patients, who underwent slow dilation and long-duration EPBD for CBDS with ENBD (eNbd group, n = 154) or ERBD (eRbd group, n = 129) from January 2022 to September 2023.

Methods: Propensity score matching (PSM) was used to balance preoperative baselines and intraoperative specifics, resulting in 220 matched patients (110 patients per group). The incidence rate of post-ERCP pancreatitis (PEP) was compared between the two groups, and risk factors for PEP were analyzed.

Results: After PSM, there were no significant differences in the baseline between the eNbd group and the eRbd group. The eNbd group exhibited significantly greater reduction in serum bilirubin levels compared to the eRbd group. Before PSM, the incidence rate of PEP was 2.6% (4/154) in the eNbd group and 8.5% (11/129) in the eRbd group (p = 0.027). After PSM, the incidence rate of PEP was 2.7% (3/110) in the eNbd group and 9.1% (10/110) in the eRbd group (p = 0.045). In addition, subgroup analysis revealed that patients with multiple stones may have a higher likelihood of developing PEP.

Conclusion: ENBD may be an optimal choice for patients with CBDS undergoing EPBD, and the presence of multiple stones may be particularly relevant when considering the risk of PEP.