Endoscopic Biliary Drainage —The Effectiveness of Biliary Drainage in Consideration of the Hepatic Functional Reserve—

: The present study was designed to determine whether it is possible to estimate the effectiveness of biliary decompression, the duration of functioning patency of the prosthesis and the prognosis after drainage using the hepatic functional reserve (HFR) as an index, in patients with malignant obstructive jaundice in which endoscopic biliary drainage (EBD) or percutaneous transhepatic biliary drainage (PTBD) is performed. Evaluation of HFR was based on the plasma cyclic AMP level at 10 min. in the glucagon test (cyclic AMP10). Furthermore, with respect to HFR, the effectiveness of biliary decompression by EBD was compared with that by PTBD. The criteria of bilirubin decreasing rate “b”, proposed by Shimizu et al. to determine the effectiveness of biliary decompression by PTBD were revaluated in comparison to that of EBD. The following results were obtained. 1  Cyclic AMP10 was useful to estimate the effectiveness of biliary decompression by EBD and PTBD. 2  No relationship was found between cyclic AMP10 and the duration of functioning patency of the prosthesis, which led to the inference that patency may be dependent on various factors in addition to HFR. 3  In terms of the reaction of cyclic AMP10, the prognosis was worse in the poor reaction group than in the good reaction group. It was considered that the reaction of cyclic AMP10 is useful to estimate prognosis. 4  The effectiveness of biliary decompression by EBD was better than that of PTBD in patients with nearly equal cyclic AMP10. 5  In evaluating the effectiveness of biliary, decompression by EBD, it seems to be necessary to modify the standard set points of the criteria of bilirubin decreasing rate “b”, proposed by Shimizu et al. and used with PTBD.