Sequential changes of bile contents in patients with obstructive jaundice from different etiologies.

BACKGROUND/AIMS: The decreasing of serum concentration of bilirubin and the ability of hepatocytes to excrete various biliary contents after release of obstructive jaundice are good indicators of recovery of liver function. We conducted this study to clarify whether different causes of obstructive jaundice have different effects on the biliary excretion and how they are different when obstruction is released. PATIENTS AND METHODS: Fifteen patients with obstructive jaundice undergoing percutaneous transhepatic catheter drainage or endoscopic nasobiliary drainage were classified into two groups, depending on the cause of obstruction: common bile duct stones (n = 7) and biliary tract tumors (n = 8). All patients in the gallstone group presented with acute cholangitis while only three patients in the tumor group had a positive bacteria culture in bile. Fasting biles were collected on the day of catheter placement and the 2nd, 4th, 6th, 8th, 10th day thereafter. The sequential changes of biliary concentration of bilirubin, phospholipid, cholesterol, bile salts and serum bilirubin were checked and compared between the two groups. RESULTS: The difference in the improvement of jaundice between the stone and tumor group (p > 0.05) were not significant, nor were the excretion of biliary contents after relief of obstruction. The reduction of serum bilirubin paralleled with the increased excretion of biliary bile salts and bilirubin (gamma = -0.51, p < 0.01 and gamma = -0.4, p < 0.05) in tumor group, but not in the stone group. CONCLUSIONS: The decrease of serum bilirubin and the sequential changes of bile contents after relief of obstruction are quite similar in stone and tumor induced obstructive jaundice.