The Diagnostic Value Of Serum Bile Acid For ERCP And Therapeutic Endoscopy In Patients With Obstructive Jaundice

The jaundice caused by obstruction of cholangioles, intrahepatic andextrahepatic bile duct is named obstructive jaundice and can cause seriousdamage of the liver, kidney, gastrointestinal tract, coagulation system andother systems. Liver is one of the first injuried organs and also is one of themost serious damaged organs. After biliary obstruction, there are a series ofpathophysiological changes in liver and at the earlier stage there are lots ofabnormalities in the liver function tests. The key treatment of the biliaryobstruction is biliary drainage. ERCP and its associated endoscopic techniquesis a safe, microinjury way to relieve obstruction with fewer complications andless trauma and pain and is widly used in treating benign or malignantobstructive jaundice. After relief of obstruction, the damage organs recoveredin different degree and the abnormal liver function indicators graduallyrestored too. Many studies had confirmed that serum bile acid is a sensitiveindicator of liver parenchymal damage or biliary obstruction and its rise evenas early as seen in liver biopsy. And it may be help in observation theevolution of serum bile acids and other liver function indicators before andafter ERCP and its associated endoscopic techniques in patients withobstructive jaundice.Objective:Observation the levels of serum bile acid and other liver functionindicators, to understand its evolution before and after relief of obstruction byERCP associated treatments and to explore the clinical significance inevaluating the therapeutic effect of biliary drainage.Method1. Research objects: In patients treated by ERCP associated therapy inDepartment of Gastroenterology, The Second Hospital of Hebei Medical University on January2005to December2010were collected.2. Groups: Based on the cause patients were divided into malignantobsructive jaundice group and benign obstruction jaundice group. Accordingto the drainage form, benign obstruction jaundice group was divided intoENBD group and nor ENBD group. In the benign obstruction jaundice grouppatients whose TBIL values were higher than100μmol/L were ascribed tosevere group,whose TBIL values were lower than100μmol/L were ascribedto mild group.3. Mensuration of biochemical parameters：Collection all patients' fastingvenous blood within the three days before ERCP. The fasting venous bloodwas collected at the third day for the fist time and at the7th day for the secondtime after drainage in benign obstruction jaundice group. Similarly, the bloodwas collected at the third day for the fist time, at the7th day for the secondtime and at the12th day for the third time. With the blood sample serum bileacid and other liver function indicators were measured in the BiochemicalLaboratory of Second Hospital Hebei Medical University.Results1. In the patients with benign obstructive jaundice, serum bile aciddecreased obviously3days after the biliary drainage. The decrease wasstatistically significant(P<0.01). Compare with the level3days after thebiliary drainage, serum bile acid7days after the biliary drainage decreaseslightly, and no statistically difference was found(P>0.05). TBIL, DBIL, IBIL,ALP, GGT, ALT and AST levels were significantly different in the patientsbefore drainage or3days after drainage when compared to that of patients3days after drainage or7days after drainage(P<0.05).2. In the patients with malignant obstructive jaundice, the serum bileacids decreased obviously3days after the biliary drainage. The decrease inbile acids was statistically significant(P<0.01). Compared with the level3days after the biliary drainage, serum bile acid levels7or12days after thebiliary drainage decreased slightly, and no statistically difference wasfound(P>0.05). TBIL, DBIL and IBIL levels were significantly different in the patients before drainage or3days after drainage when compared to that ofpatients3days after drainage or7days after drainage(P<0.05). Differencebetween7days after drainage and12days after drainage in respect of TBIL,DBIL and IBIL values was not significant(P>0.05). ALB and CHE levelswere not significantly different in patients before drainage when compared tothat of patients after drainage(P>0.05).3. In the patients with malignant obstructive jaundice, the levels of serumbile acid, TBIL, DBIL, IBIL, ALP and GGT were higher and the levels ofCHE and ALB were lower when compared to that of benign obstructionjaundice group. Difference between malignant obsructive jaundice group andbenign obstruction jaundice group in respect of serum bile acids, TBIL, DBIL,IBIL, ALP, GGT, CHE and ALB values prior to drainage and after drainagewas significant(P<0.05). Difference between malignant obsructive jaundicegroup and benign obstruction jaundice group in respect of ALT and ASTvalues before drainage was not significant(P>0.05). However they weresignificant after drainage.(P<0.05).4. Difference between ENBD and nor ENBD groups in respect of serumbile acid, TBIL, DBIL, IBIL, ALP, GGT, AST, ALT, ALB and CHE valuesprior to drainage and7days after drainage was not significan(tP>0.05).serumbile acid levels3days after drainage was significantly different in ENBDgroups in which serum bile acid levels was lower when compared to that ofnor ENBD groups(P<0.05).5. Difference between severe and mild groups in respect of AST, GGT,ALB and CHE values prior to drainage was not significant(P>0.05). serumbile acid, TBIL, DBIL and IBIL levels prior to drainage were significantlydifferent in severe groups when compared to that of mild groups(P<0.01).Difference between severe and mild groups in respect of serum bile acidsvalues3days after drainage was not significant(P>0.05).6. If the preoperative levels of serum bile acid and other liver functionindicators were regarded as one, the ratios of serum bile acid and other liverfunction indicators were calculated. We can see that serum bile acid felt fastly and TBIL, DBIL IBIL, ALP, GGT, ALT, and AST decreased gently.However ALB and CHE had not changed significantly.Conclusions1. Serum bile acid felt fastly after relief of obstruction in patients withbenign or malignant obstruction and it is a sensitive indicators reflecting therelief of obstruction.2. Serum bile acid and other liver function indicators in patients withMalignant obstruction were significantly higher than that in patiens withbenign obstruction.3. ENBD is benefit for cholestasis recovering in short-term in patienswith benign obstruction.4. There is some value for serum bile acid to identify mild obstructionwith severe obstruction in patiens with benign obstruction.