Comparison of Clinical Outcomes Between Endoscopic Nasobiliary Drainage and Biliary Stenting in Single-Stage Triple-Endoscopic Combined Therapy for Gallbladder and Common Bile Duct Stones

Comparison of Clinical Outcomes Between Endoscopic Nasobiliary Drainage and Biliary Stenting in Single-Stage Triple-Endoscopic Combined Therapy for Gallbladder and Common Bile Duct Stones | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of Clinical Outcomes Between Endoscopic Nasobiliary Drainage and Biliary Stenting in Single-Stage Triple-Endoscopic Combined Therapy for Gallbladder and Common Bile Duct Stones Han Li, JianFeng Bin, Yiwei Dai, Wei Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8640559/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Introduction: The management of gallbladder stones combined with common bile duct stones (CBDS) remains a clinical challenge. While laparoscopic cholecystectomy (LC) with endoscopic retrograde cholangiopancreatography (ERCP) is widely adopted, the optimal intraoperative biliary drainage strategy during single-stage triple-endoscopic (laparoscopic, choledochoscopic, and duodenoscopic) combined therapy is unclear. This study compared the clinical outcomes of endoscopic nasobiliary drainage (ENBD) versus endoscopic retrograde biliary drainage (ERBD) within this advanced framework. Methods: A retrospective cohort study was conducted on 82 patients who underwent single-stage triple-endoscopic combined therapy at two centers between January 2022 and November 2025. Patients were categorized into ENBD (n=47) and ERBD (n=35) groups. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. Primary outcomes included overall complication rates (Clavien-Dindo classification), operative blood loss, postoperative length of stay (LOS), total LOS, and hospitalization costs. Results: After IPTW adjustment, baseline covariates were well-balanced. The ERBD group exhibited a significantly higher overall complication rate compared to the ENBD group (83.8% vs. 57.9%, P=0.020). Weighted multivariable logistic regression confirmed ERBD as an independent risk factor for overall complications (adjusted OR=5.83, 95% CI: 1.22–27.75, P=0.027). No significant differences were observed in operative blood loss, postoperative LOS, total LOS, or total hospitalization costs between the two groups. Conclusion: In patients undergoing single-stage triple-endoscopic combined therapy for gallbladder stones with CBDS, ENBD is associated with a significantly lower risk of postoperative overall complications compared to ERBD. Although both drainage methods result in similar postoperative recovery times and hospitalization costs, ENBD appears to be a safer short-term biliary drainage option within this advanced surgical framework. We recommend individualized selection of the drainage method based on the patient’s specific risk profile. Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 29 Apr, 2026 Reviewers agreed at journal 26 Apr, 2026 Reviewers invited by journal 24 Mar, 2026 Editor invited by journal 05 Mar, 2026 Editor assigned by journal 21 Jan, 2026 Submission checks completed at journal 21 Jan, 2026 First submitted to journal 19 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8640559","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":611520568,"identity":"9c7e782b-4f5b-4905-8ce2-224b00ef53fe","order_by":0,"name":"Han Li","email":"","orcid":"","institution":"Zunyi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Han","middleName":"","lastName":"Li","suffix":""},{"id":611520569,"identity":"677434c4-f6f9-48b0-88c8-05f0338e8d1a","order_by":1,"name":"JianFeng Bin","email":"","orcid":"","institution":"Zunyi Medical University","correspondingAuthor":false,"prefix":"","firstName":"JianFeng","middleName":"","lastName":"Bin","suffix":""},{"id":611520570,"identity":"90db0604-a7fd-45e1-99c5-556bacb3c952","order_by":2,"name":"Yiwei Dai","email":"","orcid":"","institution":"Zunyi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yiwei","middleName":"","lastName":"Dai","suffix":""},{"id":611520571,"identity":"c1853513-cf1b-428f-8476-d8a3653f092d","order_by":3,"name":"Wei Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYHACNgjJ3tj48AMx6nngWngONxtLkKSFQSK9TYCHGC32/IufPfi447Acn+TDNgYJBjs53QZCtkg8MzeceeawMZt0YtuDAoZkY7MDBLWcYZPmbbud2Cad2G4gwXAgcRtRWv623a5vkzzYJsFDlBb+HjZpxrbbCWwSjMRqucFmJtnb9t+wjScRGMgGRPiFvf/wM4mfbWny8u3HHz78UGEnR1ALg0QCMs+AkHIQ4Cdo6CgYBaNgFIx4AABxkz3lQN2ixwAAAABJRU5ErkJggg==","orcid":"","institution":"First People’s Hospital of Zunyi","correspondingAuthor":true,"prefix":"","firstName":"Wei","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2026-01-19 14:53:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8640559/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8640559/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105506636,"identity":"21875a89-0413-4196-811f-bd34fb2f0aea","added_by":"auto","created_at":"2026-03-26 19:11:12","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1320352,"visible":true,"origin":"","legend":"","description":"","filename":"Prototype0108.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8640559/v1_covered_2ecb3fa0-e04e-47f3-a369-5d9b6eb92fc6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of Clinical Outcomes Between Endoscopic Nasobiliary Drainage and Biliary Stenting in Single-Stage Triple-Endoscopic Combined Therapy for Gallbladder and Common Bile Duct Stones","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8640559/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8640559/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction: The management of gallbladder stones combined with common bile duct stones (CBDS) remains a clinical challenge. While laparoscopic cholecystectomy (LC) with endoscopic retrograde cholangiopancreatography (ERCP) is widely adopted, the optimal intraoperative biliary drainage strategy during single-stage triple-endoscopic (laparoscopic, choledochoscopic, and duodenoscopic) combined therapy is unclear. This study compared the clinical outcomes of endoscopic nasobiliary drainage (ENBD) versus endoscopic retrograde biliary drainage (ERBD) within this advanced framework.\u003c/p\u003e\n\u003cp\u003eMethods: A retrospective cohort study was conducted on 82 patients who underwent single-stage triple-endoscopic combined therapy at two centers between January 2022 and November 2025. Patients were categorized into ENBD (n=47) and ERBD (n=35) groups. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. Primary outcomes included overall complication rates (Clavien-Dindo classification), operative blood loss, postoperative length of stay (LOS), total LOS, and hospitalization costs.\u003c/p\u003e\n\u003cp\u003eResults: After IPTW adjustment, baseline covariates were well-balanced. The ERBD group exhibited a significantly higher overall complication rate compared to the ENBD group (83.8% vs. 57.9%, P=0.020). Weighted multivariable logistic regression confirmed ERBD as an independent risk factor for overall complications (adjusted OR=5.83, 95% CI: 1.22–27.75, P=0.027). No significant differences were observed in operative blood loss, postoperative LOS, total LOS, or total hospitalization costs between the two groups.\u003c/p\u003e\n\u003cp\u003eConclusion: In patients undergoing single-stage triple-endoscopic combined therapy for gallbladder stones with CBDS, ENBD is associated with a significantly lower risk of postoperative overall complications compared to ERBD. Although both drainage methods result in similar postoperative recovery times and hospitalization costs, ENBD appears to be a safer short-term biliary drainage option within this advanced surgical framework. We recommend individualized selection of the drainage method based on the patient’s specific risk profile.\u003c/p\u003e","manuscriptTitle":"Comparison of Clinical Outcomes Between Endoscopic Nasobiliary Drainage and Biliary Stenting in Single-Stage Triple-Endoscopic Combined Therapy for Gallbladder and Common Bile Duct Stones","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-26 19:10:58","doi":"10.21203/rs.3.rs-8640559/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-29T07:03:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"178151792753925030723211900171611998554","date":"2026-04-26T23:12:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-24T16:22:49+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-06T04:32:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-21T12:02:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-21T12:00:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2026-01-19T14:16:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f6571483-a4ed-43ed-a9ff-3375034c07ae","owner":[],"postedDate":"March 26th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-04-29T07:03:55+00:00","index":43,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-26T19:10:58+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-26 19:10:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8640559","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8640559","identity":"rs-8640559","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}