Total bilirubin is a good discriminator between benign and malignant biliary strictures

Vasilieva, Larisa; Alexopoulou, Alexandra; Papadhimitriou, Stephanos I.; Romanos, Andreas; Xynopoulos, Dimitris; Dourakis, Spyros P.

doi:10.1111/j.1477-2574.2011.00400.x

Cited by 4 publications

(4 citation statements)

References 6 publications

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“…This finding was compatible with the previous study, which reported higher total bilirubin and biliary tract enzyme in patients with obstructive jaundice induced by malignant etiology. 27,28 On the other hand, patients from the ER or those referred from other hospital had higher qSOFA scores and inflammatory markers upon admission. These patients, having abrupt abdominal pain, fever, or gastrointestinal upset, would have sought medical help in a timely manner even during the lockdown period, leading to shorter hospital stays.…”

Section: Discussionmentioning

confidence: 98%

Lockdown period during SARS COVID-19 endemic outbreak in Taiwan did not cause an increase of the complications nor mortality of patients received endoscopic retrograde cholangiopancreatography: A single-center retrospective study

Chang

Hou

et al. 2022

Journal of the Chinese Medical Association

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Background: Coronavirus disease 2019, known as a widespread, aerosol spreading disease, has affected >549 000 000 people since 2019. During the lockdown period, dramatic reduction of elective endoscopic procedures, including endoscopic retrograde cholangiopancreatography, had been reported worldwide, leading to delayed diagnosis and treatment. Nevertheless, whether patients' hospital stays and complication rate of endoscopic retrograde cholangiopancreatography (ERCP) during the lockdown period were influenced by the pandemic still remains controversial. Methods: Patients who diagnosed with obstructive jaundice and acute cholangitis in the lockdown period, May 16 to July 26, 2021, were compared to the same prepandemic period in 2019. Results: A total of 204 patients in 2019 and 168 patients in 2021 were diagnosed with acute biliary cholangitis or obstructive jaundice, and 82 of the patients in 2019 and 77 patients in 2021 underwent ERCP (p = 0.274). Patients whose quick Sequential Organ Failure Assessment (qSOFA) score was ≥ 2 occurred more during the lockdown period than during the normal period (24/77, 31.1% vs 12/82, 14.6%; p = 0.013). The initial laboratory data, including, total bilirubin (4.12 in 2021 vs 3.08 mg/dL in 2019; p = 0.014), gamma-glutamyl transferase (378 in 2021 vs 261 U/L in 2019; p = 0.009), and alkaline phosphatase (254 in 2021 vs 174 U/L in 2019; p = 0.002) were higher during the lockdown period compared to 2019. Hospital stay was statistically significant longer in the lockdown period (11 days [7.00-22.00] in 2021 vs 8 days in 2019 [6.00-12.00]; p value = 0.02). Multivariate analysis showed that qSOFA ≥ 2 (hazard ratio [HR] = 3.837, 95% confidence interval [CI] = 1.471-10.003; p = 0.006), and malignant etiology (HR = 2.932, 95% CI = 1.271-6.765; p = 0.012) were the statistically significant factors for a prolonged hospital stay, which was defined as hospital stay >21 days. ERCP-related complications and mortality rate were not statistically different between the two periods. Conclusion: Patients from May 16 to July 26, 2021, the lockdown period, had longer hospital stays and higher biliary tract enzyme levels, which indicated more severe disease. Nevertheless, ERCP could be safely and successfully performed even during the medical level 3 alert lockdown period without causing an increase in procedure-related complications and mortality.

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Section: Discussionmentioning

confidence: 98%

Lockdown period during SARS COVID-19 endemic outbreak in Taiwan did not cause an increase of the complications nor mortality of patients received endoscopic retrograde cholangiopancreatography: A single-center retrospective study

Chang

Hou

et al. 2022

Journal of the Chinese Medical Association

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“…Garcea et al have demonstrated that serum bilirubin >100 µmol/L is closely correlated with a diagnosis of malignancy irrespective of the initial reason for investigation and independently of any other investigation [5]. Patients were significantly less likely to harbour a malignancy if the serum bilirubin was < 100 µmol/L, a finding replicated in many other studies [6,7,8,9]. This is possibly due to progressive and irreversible extra-luminal compression of the biliary tree that is associated with a malignancy.…”

Section: Discussionmentioning

confidence: 84%

“…that an elevated serum bilirubin > 100 µmol/L has been shown to be a reliable predictor of pancreatic/biliary malignancy, with a high sensitivity and specificity [5]. This link between elevated bilirubin and pancreatic/biliary malignancy has been replicated in other studies [6][7][8][9][10][11]. However there is no published data on the sensitivity and specificity of serum bilirubin in inadequate (C1), benign (C2) and indeterminate (C3) cytology.…”

Section: Global Journal Of Surgerymentioning

confidence: 82%

Serum Bilirubin Levels Can Predict Pancreatic and Biliary Malignancies in Patients with Obstructive Jaundice and Non-conclusive Cytology

Khan¹,

Lapsia²,

Aslam³

et al. 2018

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Background: Elevated serum bilirubin has been shown to be a reliable predictor of pancreatic and biliary malignancy but the relationship between serum bilirubin and inadequate (C1), benign (C2) and indeterminate (C3) cellular samples has not been explored. The aim of this study is to determine the relationship between serum bilirubin and pancreatic, biliary or ampullary malignancy in the context of non-confirmatory cytology. Methods: This is a retrospective analysis of patients with obstructive jaundice undergoing investigation for possible pancreatic, peri-ampullary or biliary malignancy between 2009 and 2013. Results: 135 patients were included; 84 had a malignant diagnosis and 51 benign. All patients with C4 or C5 cytology (n=49) had confirmed malignancy. 35 out of 86 C1-C3 samples were falsely negative. ROC curve analysis demonstrated a strong association (AUC 0.912) between elevated serum bilirubin and malignancy; serum bilirubin ≥ 100 µmol/L had a sensitivity of 86% and a specificity of 88%. In the C1-C3 subgroup, this association was maintained (AUC 0.905). Serum bilirubin ≥ 100 µmol/L had a sensitivity of 80% and specificity of 88%. Using this cutoff highlighted 28 out of 35 of the malignancies missed by cytology (p = 0.003). Conclusion: Our study demonstrates that a serum bilirubin ≥ 100 µmol/L is associated with malignancy and this relationship is maintained in C1-C3 cytology. When faced with non-confirmatory cytology in the absence of a benign aetiology and an elevated serum bilirubin ≥ 100 µmol/L, we advocate more aggressive investigation to avoid missing an occult malignancy.

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“…In our scoring system, DBil increase (>7 umol/L) is the only one clinical variable absorbed and the OR is 36.968 (95% CI 12.74–107.277) that weighted the highest score. For obstructive jaundice which can be frequently observed in patients with bulging duodenal papilla, some clinical characteristics has presented potential in the differential diagnosis of the benign and malignant cause like CA199 and total bilirubin ( 15 – 18 ). In this study, the normal range of TBil, DBil, IBil, and CA19-9 were 1.71–17.1 umol/L, 1.71–7 umol/L, 1.7–13.7 umol/L, and 0–37 Ku/L respectively.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Features and Clinical Factor for Preoperative Prediction in the Bulging Duodenal Papilla With Malignancy

Wang

et al. 2021

Front. Oncol.

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BackgroundTo investigate characteristic clinical and imaging features and establish a scoring system for preoperative prediction of malignancy in the bulging duodenal papilla.MethodsA total of 147 patients with bulging duodenal papilla (Benign enlargement n = 67; malignant enlargement n = 80) from our hospital between 2010 and 2020 were retrospectively analyzed. We investigated meaningful clinical and CT imaging features and established the score model through logistic regression and weighted. The calibration test, the ROC, AUC, and cut-off points were performed in score model. The model was also divided into three score ranges for convenient clinical evaluation.ResultsThree clinical and CT imaging features were finally included in the score model including direct bilirubin (DBil) increase >7 umol/L (3 points), pancreatic duct (PD) dilation >5 mm (2 points), and irregular shape (2 points). The AUCs of the primary predictive model and score model were 0.896 (95% CI, 0.835–0.940) and 0.896 (95% CI, 0.835–0.940), respectively. This scoring system presented with a sensitivity of 78.8% and a specificity of 88.1% when using 2.5 points as cutoff value. Three score ranges were also proposed for convenient clinical use as follows: 0–2 points; 3–4 points; 5–7 points. The number of patients with malignant duodenal papillary enlargement increased with the increasing scores.ConclusionsWe proposed a convenient scoring system to preoperative predict malignancy in the bulging duodenal papilla.

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Total bilirubin is a good discriminator between benign and malignant biliary strictures

Cited by 4 publications

References 6 publications

Lockdown period during SARS COVID-19 endemic outbreak in Taiwan did not cause an increase of the complications nor mortality of patients received endoscopic retrograde cholangiopancreatography: A single-center retrospective study

Lockdown period during SARS COVID-19 endemic outbreak in Taiwan did not cause an increase of the complications nor mortality of patients received endoscopic retrograde cholangiopancreatography: A single-center retrospective study

Serum Bilirubin Levels Can Predict Pancreatic and Biliary Malignancies in Patients with Obstructive Jaundice and Non-conclusive Cytology

Radiographic Features and Clinical Factor for Preoperative Prediction in the Bulging Duodenal Papilla With Malignancy

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