Change in serum and biliary esterified bile acids in patients with extrahepatic cholestasis during percutaneous transhepatic cholangiodrainage.

Eighteen patients with total extrahepatic cholestasis undergoing PTCD were classified into three groups, depending on the bilirubin decrease rate at two weeks after PTCD. Serum and biliary esterified bile acids in each group were measured before PTCD and at 24 hours, 48 hours, 1 week, and 2 weeks after PTCD. Bile acids were measured by Okuyama's methods (HPLC), and esterified bile acids were calculated from the difference between samples treated with sulfatase or beta-glucuronidase for enzymatic hydrolysis and untreated samples measured at the same time. The following results were obtained. The percentages of biliary esterified bile acids in total bile acids were as follows: before PTCD, in the fair improvement group, sulfate (S) = 6.4 +/- 4.6% (mean +/- S.D.), glucuronide (G) = 11.7 +/- 9.0%; in the poor improvement group, S = 2.8 +/- 1.6%, G = 1.0 +/- 0.9% and at 24 hours after PTCD, in the fair group, S = 9.1 +/- 7.5%, G = 7.5 +/- 4.3%; in the poor group, S = 2.9 +/- 2.4%, G = 1.7 +/- 1.1%. The percentages of esterified bile acids in the fair group were higher than in the poor group, and significant differences were noted in G (p less than 0.05). Thus PTCD is expected to reduce jaundice in cases with high percentages of biliary esterified bile acids before and shortly after PTCD.