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01-12-2014 | Original Article

Preoperative Bile Replacement Improves Immune Function for Jaundiced Patients Treated with External Biliary Drainage

Authors: Yuko Yoshida, Tetsuo Ajiki, Kimihiko Ueno, Kenta Shinozaki, Sae Murakami, Taro Okazaki, Taku Matsumoto, Ippei Matsumoto, Takumi Fukumoto, Makoto Usami, Yonson Ku

Published in: Journal of Gastrointestinal Surgery | Issue 12/2014

Abstract

Background

Although preoperative biliary drainage in jaundiced patients is controversial, external biliary drainage (EBD) is beneficial for infection control in patients with biliary cancers. When EBD is performed, additional bile replacement (BR) has the benefit of improving impaired intestinal barrier function, but the detailed mechanism remains unknown. We examined the effect of bile replacement on immune functions over the duration of BR in jaundiced patients.

Methods

Fifteen patients were enrolled into this prospective study. BR was started soon after the total serum bilirubin concentration reached 5.0 mg/dl and was continued for 14 days. Drained bile was given two times orally (2 × 100 ml/day). Concanavalin A (Con A)- and phytohemagglutinin (PHA)-stimulated lymphocyte proliferation and serum diamine oxidase (DAO) activity were measured before starting and during BR. Twenty patients with EBD and no BR were analyzed as a control group.

Results

Serum liver enzymes, prothrombin time–international normalized ratio (PT-INR), and responses to Con A and PHA gradually improved over the 14 days of BR, but percentages of lymphocytes and DAO levels did not. PT-INR, and Con A and PHA responses did not improve during EBD in the control group. PT-INR significantly decreased in patients with a greater fraction of their drained bile replaced.

Conclusions

Our results indicate that preoperative BR using as large a quantity of bile as possible is useful for improving blood coagulability and cellular immunity in patients with EBD.

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Title: Preoperative Bile Replacement Improves Immune Function for Jaundiced Patients Treated with External Biliary Drainage
Authors: Yuko Yoshida
Tetsuo Ajiki
Kimihiko Ueno
Kenta Shinozaki
Sae Murakami
Taro Okazaki
Taku Matsumoto
Ippei Matsumoto
Takumi Fukumoto
Makoto Usami
Yonson Ku
Publication date: 01-12-2014
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 12/2014
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-014-2674-2

At a glance: The STEP trials

Springer Medicine

Preoperative Bile Replacement Improves Immune Function for Jaundiced Patients Treated with External Biliary Drainage

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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