Biliary Pressure Monitoring and its Clinical Correlation in Patients with Obstructive Jaundice

Abstract

Introduction: Biliary pressure has been postulated to have a direct impact on cholangiovenous reflex and cholangitis in patients with obstructive jaundice .Only limited human studies are available regarding biliary pressure monitoring. Methods: A total of 30 patients with obstructive jaundice either benign or malignant and who didn't undergo any interventional or surgical procedure for relief of the jaundice were included in the study.The clinical and demographic details were noted and Liver function test was taken on the day of biliary decompression. Bile pressure was monitored intraoperatively with a pressure transducer system proximal to the obstruction. In patients who undergo PTBD ,bile pressure was noted immediately after inserting the Chiba needle. Results: A total of 30 patients were included in the study (19 males and 11 females). The mean age of the patients included were 55.9 years.The etiology of obstructive jaundice was periampullary carcinoma in 13 patients , carcinoma head of pancreas in 3 patients, carcinoma gallbladder in 3 patients , hilar cholangiocarcinoma in 6 patients ,postcholecystectomy biliary stricture in 1 patient ,Chronic pancreatitis with distal CBD compression in 2 patients, Post Liver transplant CBD stricture in 1 patient and choledocholithiasis with cholangitis in patient. (19 distal obstruction and 11 proximal obstruction).The mean biliary pressure in patients with distal obstruction was 22.3 and in patients with Proximal obstruction was 18.09. The highest recorded biliary pressure was 52 in periampullary carcinoma. Conclusions: First study of its kind to document the biliary pressure and the bile characteristics in obstructive jaundice of various etiologies.