Current Perspectives on Endoscopic Nasobiliary Drainage: Optimizing Patient Management and Preventing Complications

Endoscopic nasobiliary drainage (ENBD) is a well-established technique for biliary decompression in both benign and malignant conditions. Over the past decades, its role has been extensively evaluated in comparison with endoscopic biliary stenting and percutaneous transhepatic biliary drainage. ENBD provides distinct clinical advantages, including real-time monitoring of bile output, the possibility to perform irrigation, and the ability to collect bile samples for cytological analysis. However, it also presents specific challenges such as patient discomfort, tube dislodgement, and the need for careful maintenance. This narrative review synthesizes current evidence from randomized controlled trials, retrospective cohorts, systematic reviews, and meta-analyses, highlighting the main indications, technical innovations, comparative outcomes with alternative drainage techniques, and strategies to prevent complications. Furthermore, it discusses emerging approaches aimed at improving patient tolerance, procedural efficiency, and environmental sustainability, offering an updated framework for optimizing patient management in both benign and malignant biliary obstruction.