Clinical Significance of White Bile (Bilirubin-Free Bile) in Malignant Bile Duct Obstruction / 대한소화기학회지

BACKGROUND/AIMS: White bile is colorless, translucent fluid found occasionally in malignant bile duct obstruction (MBO). Little information is available on the cause and effect of white bile. The aim of this study was to determine the frequency and clinical significance of white bile in MBO. METHODS: Bile was aspirated during endoscopic retrograde cholangiopancreatography in consecutive patients with MBO. White bile was defined as bile bilirubin or=1.5 mg/dL in the bile. Two groups were compared prospectively for the duration of jaundice, itching, cholangitis, level of obstruction, and decremental rate of bilirubin after the insertion of 7 Fr endoscopic nasobiliary drainage until the insertion of metal stent or 10 Fr plastic stent. RESULTS: Among 60 patients with MBO, 16 (26.7%) had white bile. WBC count in blood was higher (9,456/mm3 vs. 7,400/mm3, p=0.029) and cholangitis was more common (11/16 vs. 7/44, p=0.000) in white than yellow bile group. Proximal portion of MBO had no communication with GB in 9/16 patients with white bile group and 17/44 patients with yellow bile group (p>0.05). Mean survival of the inoperable 35 patients was 242 days in yellow bile and 227 days in white bile group (p>0.05). CONCLUSIONS: White bile in MBO was not rare and was associated with cholangitis. Gallbladder did not seem to play a role in the formation of white bile. Further study for the pathogenesis and prognosis of white bile in MBO will be necessary.

Concurrent Yellow-to-white and Black Extrahepatic Bile Duct Stones / 대한소화기내시경학회지

Extrahepatic bile duct stones are largely classified into primary and secondary stones. Most extrahepatic bile duct stones are known to migrate from the gallbladder, and thus named secondary stones. Primary stones are formed de novo in the extrahepatic bile duct and are rare. We present an interesting case of a 61 year-old man with obstructive jaundice and biliary sepsis in whom a black extrahepatic bile duct stone and a yellow-to white extrahepatic bile duct stone had been removed during single session of endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy.