Su1441 The Rate of Decline in the Levels of Bilirubin and Alkaline Phosphatase After Therapeutic ERCP for the Relief of Common Bile Duct Obstruction

Abstract

The Rate of Decline in the Levels of Bilirubin and Alkaline Phosphatase After Therapeutic ERCP for the Relief of Common Bile Duct Obstruction Kian Makipour, Mandeep Singh, Anil K. Vegesna, Larry S. Miller Temple University, Philadelphia, PA Background: In certain clinical situations it is important to know the rate of change of bilirubin and alkaline phosphatase. For example when a CBD stone is removed or a stent placed the levels of bilirubin and/or alkaline phosphatase should decrease at a certain rate. If they do not drop at that rate it may be assumed that the bile duct remains fully or partially obstructed. However, the rate of change in bilirubin and alkaline phosphatase is not clear. Purpose: To evaluate the rate of change in bilirubin and alkaline phosphatase after therapeutic ERCP for the relief of common bile duct obstruction. Methods: A retrospective review of 86 patients (52Yrs, 32M, 54F, 27Caucasian, 25African American, 33Hispanic and 1Asian) with CBD obstruction and elevated bilirubin and/or alkaline phosphatase was performed to determine the rate of change of the levels of bilirubin and alkaline phosphatase during the CBD obstruction and after relief of the CBD obstruction. 86 patients with CBD obstruction had either a stone removed (86 patients) and or a stent placed (20 patients) to relieve the obstruction. Levels of alkaline phosphatase and bilirubin were followed for up to five days or until the patient was discharged from the hospital. Results: The initial alkaline phosphatase, total bilirubin and direct bilirubin levels were 232 IU, 5 mg/dl and 3 mg/dl respectively. The rate of change for alkaline phosophtase, total bilirubin and direct bilirubin levels were -7.28 IU/L, -0.59 mg/ dl and -0.36 mg/dl per day respectively (graph 1 and 2). Conclusions: We measured the rate of change of alkaline phosphatase and bilirubin after relief of CBD obstruction. The rate of change in alkaline phosphatase levels was greater than the rate of change in bilirubin levels after relief of CBD obstruction. We plan to use these rates of change in the future to monitor patients after relief of CBD obstruction.