C Y Chen1, S C Shiesh, X Z Lin. 1. Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
Abstract
BACKGROUND/AIMS: The recovery of liver function after biliary drainage in patients with obstructive jaundice may be different depending on the severity and duration of the obstruction. We conducted this study to determine whether there are any clinical factors that can be used to monitor the course of recovery. METHODOLOGY: Serum and bile from 12 patients were collected for biochemical testing on the day of drainage and every 3 days for 6 days. Liver function was evaluated by the indocyanine green retention test (ICG R15) before and 6 days after decompression. Patients with an ICG R15 reduction ratio of less than 50% were considered to have a poor recovery (group 1, n = 6), while a good recovery was indicated by a reduction ratio higher than 50% (group 2, n = 6). Sequential data were compared between the groups and correlated with the results of the ICG test. RESULTS: After drainage, the patients in group 1 had less bile acid excretion on day 3 (1.0 +/- 0.8 vs. 3.4 +/- 1.1 mmol/day, p < 0.05), a slower reduction ratio of serum bilirubin on day 3 (0.38 +/- 0.14 vs. 0.60 +/- 0.12, p < 0.05) and more biliary output on day 6 (1.11 +/- 0.25 vs. 0.60 +/- 0.25 L/day, p < 0.05). The ICG R15 reduction ratio was well correlated with the bilirubin reduction ratio, the bile volume and the amount of excreted bile acids checked on day 3 (gamma = 0.73, -0.71 and 0.74, respectively, p < 0.01). CONCLUSIONS: The presence of choleresis implies ductular cell hyperplasia, while decreased excretion of bile acids and a slow reduction of hyperbilirubinemia represents severe liver damage. Both conditions are sequelae of prolonged obstruction; therefore, they might indicate a long and poor recovery.
BACKGROUND/AIMS: The recovery of liver function after biliary drainage in patients with obstructive jaundice may be different depending on the severity and duration of the obstruction. We conducted this study to determine whether there are any clinical factors that can be used to monitor the course of recovery. METHODOLOGY: Serum and bile from 12 patients were collected for biochemical testing on the day of drainage and every 3 days for 6 days. Liver function was evaluated by the indocyanine green retention test (ICG R15) before and 6 days after decompression. Patients with an ICG R15 reduction ratio of less than 50% were considered to have a poor recovery (group 1, n = 6), while a good recovery was indicated by a reduction ratio higher than 50% (group 2, n = 6). Sequential data were compared between the groups and correlated with the results of the ICG test. RESULTS: After drainage, the patients in group 1 had less bile acid excretion on day 3 (1.0 +/- 0.8 vs. 3.4 +/- 1.1 mmol/day, p < 0.05), a slower reduction ratio of serum bilirubin on day 3 (0.38 +/- 0.14 vs. 0.60 +/- 0.12, p < 0.05) and more biliary output on day 6 (1.11 +/- 0.25 vs. 0.60 +/- 0.25 L/day, p < 0.05). The ICG R15 reduction ratio was well correlated with the bilirubin reduction ratio, the bile volume and the amount of excreted bile acids checked on day 3 (gamma = 0.73, -0.71 and 0.74, respectively, p < 0.01). CONCLUSIONS: The presence of choleresis implies ductular cell hyperplasia, while decreased excretion of bile acids and a slow reduction of hyperbilirubinemia represents severe liver damage. Both conditions are sequelae of prolonged obstruction; therefore, they might indicate a long and poor recovery.