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Background:An alternative to intravenous is nasogastric fluid administration through normal functioning gut. Though not common, this practice has significance in mass causalities and elective situations.Aim:The study was designed to compare nasogastric and intravenous fluid resuscitation in malignant obstructive jaundice (OJ) and their effect on endotoxemia.Materials and Methods:Sixty patients with malignant OJ undergoing endoscopic biliary drainage were randomized into two groups. A total of 4 l of fluid (Ringer's lactate) was administered to Group A through nasogastric tube and to Group B through intravenous route for 48 h. Vital parameters, serum bilirubin, serum creatinine, creatinine clearance rate, electrolytes, and endotoxemia were monitored.Results:Significant improvement in blood pressure (Group A, P = 0.014; Group B, P = 0.020) and significant decrease in serum bilirubin level (Group A, P = 0.001; Group B, P > 0.0001) was observed in both groups after resuscitation. Significantly decreased (P = 0.036) post hydration endotoxin level was observed in Group A as compared to Group B. Febrile events were significantly higher (P = 0.023) in Group B as compared to Group A (6 vs 0). Electrolyte abnormalities were found more in Group B, however statistically insignificant.Conclusion:In OJ patient undergoing biliary drainage, preoperative fluid resuscitation through nasogastric tube may be helpful in reducing postoperative septic complications and endotoxemia.

Introduction: Gallbladder Cancer represents the most common and aggressive type among the biliary tree cancers (BTCs). Carcinoma Gallbladder has an unusual geographic distribution. The highest incidence of carcinoma of gallbladder is in Chileans, American Indians, and in parts of North India. Objective: The present study was designed to characterise the circulating concentrations of endotoxin and different inflammatory mediators in patients with Carcinoma Gall bladder. Methods and Material: One hundred twenty eight Carcinoma Gall bladder patients were included in the study. Enzyme-linked immunosorbent assay was used for determining the circulating concentrations of Interleukin-2 (IL-2), Interleukin-6 (IL-6), Tumor Necrosis Factor-α (TNF-α) and Endotoxins in human serum by LAL Method. A cross sectional trial was performed Results: The mean age of the patients was 50.86±12.6 years. The mean duration of jaundice was since last 74.91±50.0 days. Fifty five percent patients had cholelithiasis association with Carcinoma Gall bladder. The mean Body Mass Index (BMI) of Carcinoma Gall bladder patients were 18.33±2.8. The mean circulating concentrations of IL-2 were 33.31±56.6 pg/ml, IL-6 were 167.16±216.4 pg/ml, TNF-α were 56.00±56.7 pg/ml and endotoxin were 0.66±0.2 EU/ml. Conclusions: Mean circulating concentrations of IL-2 and TNF-α were lower and mean circulating concentrations of IL-6 were higher than the previous studies. The mean circulating concentrations of endotoxin were within the normal limits. Which concludes that cytokines may participate in gall bladder carcinogenesis and the study provides evidence for a strong link between chronic inflammation and Carcinoma Gall bladder.

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