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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(02): E203-E209
DOI: 10.1055/a-1324-2721
Original article

White bile in patients with malignant biliary obstruction is an independent factor of poor survival

Rosario Dʼalmeida
1   Department of Hepato-Gastroenterology and Digestive Oncology, Reims University Hospital, Reims, France
,
Coralie Barbe
2   Clinical Research Unit, Reims University Hospital, Reims, France
,
Valérie Untereiner
3   Université de Reims Champagne-Ardenne, BioSpecT-EA7506, Reims, France
,
Fidy Ramaholimihaso
1   Department of Hepato-Gastroenterology and Digestive Oncology, Reims University Hospital, Reims, France
,
Pascal Renard
1   Department of Hepato-Gastroenterology and Digestive Oncology, Reims University Hospital, Reims, France
,
Ganesh D. Sockalingum
3   Université de Reims Champagne-Ardenne, BioSpecT-EA7506, Reims, France
,
Roselyne Garnotel
3   Université de Reims Champagne-Ardenne, BioSpecT-EA7506, Reims, France
,
Gérard Thiefin
1   Department of Hepato-Gastroenterology and Digestive Oncology, Reims University Hospital, Reims, France
3   Université de Reims Champagne-Ardenne, BioSpecT-EA7506, Reims, France
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Abstract

Background and study aims White bile is defined as a colorless fluid occasionally found in the biliary tract of patients with bile duct obstruction. Its significance is not clearly established. Our objective was to analyze the prognostic value of white bile in a series of patients with biliary obstruction due to biliary or pancreatic cancer.

Patients and methods The study was conducted on a series of consecutive patients with malignant obstructive jaundice. They all underwent endoscopic retrograde cholangiopancreatography with collection of bile and biliary stent insertion. White bile was defined as bile duct fluid with bilirubin level < 20 µmol/L. Univariate and multivariate analyses were performed to identify variables associated with overall survival (OS).

Results Seventy-three patients were included (32 pancreatic cancers, 41 bile duct cancers). Thirty-nine (53.4 %) had white bile. The mean bile duct bilirubin level in this group was 4.2 ± 5.9 µmol/L vs 991 ± 1039 µmol/L in patients with colored bile (P < 0.0001). In the group of 54 patients not eligible for surgery, the multivariate analysis demonstrated an association between the presence of white bile and reduced OS (HR 2.3, 95 %CI 1.1–4.7; P = 0.02). Other factors independently associated with OS were metastatic extension (HR 2.8, 95 %CI 1.4–5.7) and serum total bilirubin (HR 1.003, 95 %CI 1.001–1.006). There was a significant inverse correlation between serum and bile duct bilirubin levels (r = –0.43, P = 0.0001).

Conclusion White bile in patients with inoperable malignant biliary obstruction is an independent factor of poor survival.

Supplementary material



Publication History

Received: 24 April 2020

Accepted: 21 September 2020

Article published online:
03 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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