Randomized clinical trial of the effect of intravenous fluid administration on hormonal and renal dysfunction in patients with obstructive jaundice undergoing endoscopic drainage

Padillo, Francisco J.; Briceño, Javier; Cruz, Antonio Míguez Santa; Chicano, Maite; Naranjo, Antonio; Vallejo, Juan A.; Martín‐Malo, Alejandro; Pera-Madrazo, C; Sitges‐Serra, Antonio

doi:10.1002/bjs.4790

Cited by 13 publications

(9 citation statements)

References 19 publications

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“…Indeed, endoscopic approach has been used in 89% (207/232) of the stented patients of the present study. Since it avoids any external drainage, endoscopic biliary drainage seems the most appropriate procedure to correct renal dysfunction preoperatively (37). Lastly, preoperative immunonutrition has become an important stake before PD (38) but could be less efficient in jaundiced patients with altered fat absorption, suggesting that endoscopic biliary drainage also participates to preoperative correction of malnutrition.…”

Section: Discussionmentioning

confidence: 99%

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Severe Jaundice Increases Early Severe Morbidity and Decreases Long-Term Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

Sauvanet

Boher

Paye

et al. 2015

Journal of the American College of Surgeons

104

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Section: Discussionmentioning

confidence: 99%

“…To consider both serum bilirubin level and creatinine clearance at presentation seems clinically relevant since renal function impairment is a frequent drawback of obstructive jaundice which results in depletion of the extra-cellular compartment and decreased renal perfusion (18,37).…”

Section: Discussionmentioning

confidence: 99%

Severe Jaundice Increases Early Severe Morbidity and Decreases Long-Term Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

Sauvanet

Boher

Paye

et al. 2015

Journal of the American College of Surgeons

104

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“…31 The raised plasma ANP level might be the result of the passage of bile components to the blood and is reversed to basal levels after biliary drainage, thereby improving renal dysfunction. 31,32 Furthermore, myocardial dysfunction in obstructive jaundice has been suggested to be the consequence of hemodynamic disturbances due to altering ANP concentrations, while after biliary drainage, a correlation was found between decreasing ANP concentrations and increasing cardiac output. 33 …”

Section: Experimental Studiesmentioning

confidence: 99%

Preoperative Biliary Drainage in Patients with Obstructive Jaundice: History and Current Status

Gaag

Kloek

Castro

et al. 2009

Journal of Gastrointestinal Surgery

157

114

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Rationale Preoperative biliary drainage (PBD) has been introduced to improve outcome after surgery in patients suffering from obstructive jaundice due to a potentially resectable proximal or distal bile duct/pancreatic head lesion. In experimental models, PBD is almost exclusively associated with beneficial results: improved liver function and nutritional status; reduction of systemic endotoxemia; cytokine release; and, as a result, an improved immune response. Mortality was significantly reduced in these animal models. Human studies show conflicting results. Findings For distal obstruction, currently the "best-evidence" available clearly shows that routine PBD does not yield the appreciated improvement in postoperative morbidity and mortality in patients undergoing resection. Moreover, PBD harbors its own complications. However, most of the available data are outdated or suffer from methodological deficits. Conclusion The highest level of evidence for PBD to be performed in proximal obstruction, as well as over the preferred mode, is lacking but, nevertheless, assimilated in the treatment algorithm for many centers. Logistics and waiting lists, although sometimes inevitable, could be factors that might influence the decision to opt for PBD, as well as an extended diagnostic workup with laparoscopy (on indication) or scheduled preoperative chemotherapy.

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“…Nine participants (four women) completed symptom-limited tests, after which three had definitive surgery and six were referred for palliative treatment. [2][3][4][5][6][7][8][9][10][11][12][13][14]) days, at which time all participants were still jaundiced. Oxygen consumption and oxygen pulse increased during exercise (Fig.…”

Section: Resultsmentioning

confidence: 99%

Peripheral oxygen extraction in patients with malignant obstructive jaundice

2013

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SummaryMalignant obstructive jaundice is associated with poor aerobic capacity. We measured oxygen consumption and oxygen extraction (arterial-venous oxygen content) in the legs of nine patients during cardiopulmonary exercise testing before pancreaticoduodenectomy. The median (IQR [range]) peak oxygen consumption was 67 (49-77 [32-84])% of predicted. Normal patterns of oxygen extraction were seen with increasing power towards lactate threshold. Near maximal oxygen extraction occurred at peak exercise. Femoral venous oxygen pressure and saturation exceeded baseline values whilst recovering from exercise. These findings suggest that peripheral oxygen extraction is normal during exercise in patients with malignant obstructive jaundice. The primary limitation in oxygen consumption is reduced oxygen delivery. We observed that patients with obstructive jaundice, presenting for major hepato-pancreatico-biliary surgery, were often unfit on cardiopulmonary exercise testing (CPET), with less than expected oxygen consumptions at peak exercise and at the lactate threshold. Reduced oxygen consumption may be due to reduced delivery or reduced extraction.Our patients did not have documented heart disease or abnormal resting trans-thoracic echocardiograms, but these do not exclude contractile dysfunction. Clinical studies have demonstrated that raised bilirubin is associated with raised endotoxin and inflammatory cytokine levels [1][2][3], as well as cardiovascular dysfunction characterised by hypovolaemia and reduced left ventricular systolic function [4,5]. Weber and Janicki demonstrated maximal peripheral oxygen extraction (> 70%) in patients with varying degrees of heart failure during exercise [6]. The authors demonstrated that reduced cardiac output was the primary cause of reduced aerobic capacity rather than impaired oxygen extraction. Stringer et al. showed that femoral venous oxygen saturation continues to fall after the lactate threshold but without a fall in femoral venous oxygen pressure, due to the rightshift of the haemoglobin dissociation curve in response to metabolic acidosis [7]. These changes represent normal microcirculatory responses to reduced oxygen delivery.Resuscitated septic patients have increased cardiac output, increased oxygen delivery and increased oxygen consumption [8][9][10]. However, the increase in oxygen delivery exceeds the increase in oxygen consumption, due to decreased oxygen extraction (the arterial -venous difference in oxygen content). 32© 2013 The Association of Anaesthetists of Great Britain and Ireland Anaesthesia 2014Anaesthesia , 69, 32-36 doi:10.1111 We hypothesised that poor exercise capacity in patients with obstructive jaundice was, like in septic patients, secondary to reduced oxygen extraction and a normal or raised cardiac output. MethodsThe Institutional and regional ethics committee approved the recruitment of 10 patients to this invasive pilot study. All participants provided written informed consent.We included patients eligible for pancreaticoduodenectomy, with el...

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Randomized clinical trial of the effect of intravenous fluid administration on hormonal and renal dysfunction in patients with obstructive jaundice undergoing endoscopic drainage

Abstract: Fluid administration expands the extracellular water compartment before drainage but fails to improve renal function after drainage. Definitive improvement in endocrine and renal function requires the restoration of bile flow into the duodenum.

Cited by 13 publications

References 19 publications

Severe Jaundice Increases Early Severe Morbidity and Decreases Long-Term Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

Severe Jaundice Increases Early Severe Morbidity and Decreases Long-Term Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

Preoperative Biliary Drainage in Patients with Obstructive Jaundice: History and Current Status

Peripheral oxygen extraction in patients with malignant obstructive jaundice

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