Cytokine and Endotoxin before and after External or Internal Biliary Drainage in Malignant Bile Duct Obstruction

Kang, Dae Hwan; Heo, Jeong; Kim, Gwang Ha; Moon, Jae Hyeon; Kwon, Dae Sik; Kim, Bo Suk; An, Jin Kwang; Song, Geun Am; Cho, Mong; Yang, Ung Suk

Abstract

BACKGROUND/AIMS: Malignant biliary obstruction are associated with high postoperative morbidity and mortality. This study was performed to determine the effect of external and internal biliary drainage on plasma concentrations of cytokines and endotoxin. METHODS: Twenly-one patients with malignant biliary obstruction were enrolled in this study. They were devided into two groups, PTBD (percutaneous transhepatic biliary drainage) and ERBD (endoscopic retrograde biliary drainage) groups. Then, plasma concentrations of TNF-alpha, sTNFr, interleukin 1alpha (IL-1alpha), interleukin 6 (IL-6), and endotoxin were measured before and after 1 week in PTBD and ERBD groups. RESULTS: Total bilirubin decreased significantly from 13.3+/-8.2 to 6.2+/-4.4 mg/dL after PTBD and 7.0+/-11.2 to 5.3+/-4.0 mg/dL after ERBD (p=0.005, 0.007, respectively). Plasma sTNFr in PTBD group was 5.1+/-1.4 before drainage and remained unchanged 5.5+/-1.5 ng/mL at one week after drainage (p=0.155). Plasma sTNFr in the ERBD group was 5.9+/-1.5 and 5.6+/-1.0 ng/mL before and after biliary drainage, respectivedly (p=0.333). There was no significant difference of sTNFr changes between the PTBD and ERBD groups (p=0.113). Moreover, there was no significant difference in endotoxin changes between the PTBD and ERBD groups (p=0.477). Other cytokines changed insignificantly. CONCLUSIONS: Both PTBD and ERBD did not affect significantly plasma concentrations of sTNFr and endotoxin. Although ERBD provides a better quality of life and physiologic benefit, it dose not decrease cytokines and endotoxin associated with high morbidity and mortality in patients with malignant biliary obstruction.