Bilirubin levels predict malignancy in patients with obstructive jaundice

Garcea, Giuseppe; Ngu, Wee Sing; Neal, Christopher P.; Dennison, Ashley R.; Berry, David P.

doi:10.1111/j.1477-2574.2011.00312.x

Cited by 47 publications

(57 citation statements)

References 17 publications

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“…In this study jaundice duration was significantly longer among suspected tumor patients (P value = 0.01), which is comparable to a study done by Giuseppe Garcea et al [18] ;…”

Section: Discussionsupporting

confidence: 91%

Pancreatobiliary Diseases Management by Endoscopic Ultrasonography/Endoscopic Retrograde Cholangiopancreatography Interface in Kurdistan Centre for Gastroenterology & Hepatology

Alkarboly¹

2015

AJIM

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Background: Pancreatobiliarydiseases (PBD) comprises diseases of both biliary system and pancreas and their diagnosis depends on appropriate clinical evaluation and investigations including imaging modalities like transabdominal ultrasound (TAUS), Magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT); Endoscopic ultrasound(EUS) have been found to be more sensitive than other imaging modality for detecting PBD, and less invasive than endoscopic retrograde cholangiopancreatography (ERCP). Aim of study: To compare the sensitivity and specificity of EUS with other imaging studies like ERCP, TAUS, CT scan, and MRCP/MRI for diagnosing PBD. Patients & Methods: This study conducted in Kurdistan Centre for Gastroenterology and Hepatology (KCGH) from December 2013 through December 2014, after approval of institutional board ethical committee and taking written informed consents from all patients. A total number of 100 patients were enrolled in the study. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of EUS, MRCP, and TAUS for PBD (benign & malignant). ERCP was used as a reference standard for comparison. Results: 60% were females and 40% were males; the main presenting symptoms were combined abdominal pain and obstructive jaundice. The sensitivity, specificity, PPV, NPV, and accuracy of EUS for detecting benign biliary diseases like (bile duct stone and its complications) were 96.1%, 65.2%, 86%, 83.3%, and 89%, respectively; and for detecting pancreatobiliary tumors (PBT) were 84.6%, 97.7%, 84.6%, 97.7%, and 96%, respectively. The sensitivity of TAUS, MRCP for diagnosing biliary diseases were 58%, and 60%, respectively; and their sensitivity for detecting PBT were 37.5%, and 50%, respectively. The comparison between CT scan and ERCP was not feasible statistically. Conclusion: EUS has a higher sensitivity in comparison to other imaging modalities in detecting PBD; we can depend on it in selecting patients for therapeutic ERCP, in order to avoid unnecessary ERCP and its complications. The sensitivity and specificity of EUS in KCGH is comparable to other studies elsewhere.

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“…In this study jaundice duration was significantly longer among suspected tumor patients (P value = 0.01), which is comparable to a study done by Giuseppe Garcea et al [18] ;…”

Section: Discussionsupporting

confidence: 91%

Pancreatobiliary Diseases Management by Endoscopic Ultrasonography/Endoscopic Retrograde Cholangiopancreatography Interface in Kurdistan Centre for Gastroenterology & Hepatology

Alkarboly¹

2015

AJIM

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“…These findings are in accordance with one large retrospective analysis by Garcea and colleagues who included 1026 patients. They found bilirubin levels >5.8 mg/dL highly predictive of malignancy . Two previous published studies with only small patient numbers also showed a positive correlation with malignant bile duct obstruction in bilirubin levels greater than 4.4 and 5 mg/dL respectively .…”

Section: Discussionmentioning

confidence: 80%

Novel score for prediction of malignant bile duct obstruction based on biochemical and clinical markers

Meister

Uphoff

Heinecke

et al. 2015

Aliment Pharmacol Ther

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Summary Background Early differentiation of malignant from benign bile duct obstruction is of utmost importance. Aim To identify biochemical and clinical predictors for malignancy in patients with bile duct obstruction, and establish a predictive model by combining pre‐treatment patient characteristics. A web‐based application was developed for easy assessment of malignant bile duct probability (http://www.pmal-score.org). Methods One thousand hundred and thirty‐five patients [median age 66 (52–75) years, 53% male] with bile duct obstruction of various aetiologies were retrospectively evaluated at our tertiary referral centre. Multivariate logistic regression analysis identified factors as independently significant for malignant bile duct obstruction. A predictive risk score was established using ROC analysis and applied to an external validation cohort of 101 patients. Results Three hundred and ninety‐four patients had malignant bile duct obstruction proven by surgery, while in 741 patients benign obstruction was observed. Multivariate analysis identified various clinical factors to be predictive for malignancy. On the basis of eight predictors, a risk score for malignancy was developed [X = 0.025 * [age] + 1.239 * [1 if weight loss, otherwise 0] − 0.235 * [1 if pain, otherwise 0] + 0.649 * [1 if diabetes, otherwise 0] + 0.896 * [1 if jaundice, otherwise 0] + 0.109 * [bilirubin] + 0.0007 * [γ‐GT] + 0.0003 * [AP] − 4.374]: A significant correlation between the predicted malignancy and the actual malignancy was found by ROC (AUC: 0.862; 95% CI 0.838–0.886, P < 0.0001). Conclusions This predictive risk score estimates the risk of malignancy in patients with bile duct obstruction, and it seems to be very accurate. A better prediction enables both earlier diagnosis of malignant obstructive disease and improved management of patients with bile duct obstruction, which may result in reduced morbidity and mortality.

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“…Although choledocholithiasis might be suggested as the pathogenesis, it is rare for a single factor to cause such severe jaundice. As jaundice is commonly associated with PVT, the critical jaundice in our patient was likely induced by obstruction due to common bile duct calculus and PVT, rather than a single obstructive factor, which is typically associated with much lower bilirubin levels than seen in our patient . Because C. sinensis flukes were not observed in the bile ducts, the flukes themselves did not appear to be the cause of the mechanical obstruction.…”

Section: Discussionmentioning

confidence: 75%

Clonorchis sinensis ova in bile juice cytology from a patient with severe hyperbilirubinemia and portal vein thrombosis

Fujiya

Ganno

Ando

et al. 2015

Diagnostic Cytopathology

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Infection with the trematode Clonorchis sinensis is the most common human fluke infection in East Asian populations. Although this infection is associated with obstructive jaundice or choledocholithiasis, portal vein thrombosis has not been reported. Here, we report the first case of a 60-year-old man who had both C. sinensis infection and portal vein thrombosis with severe hyperbilirubinemia (75.4 mg/dl). He initially presented with abdominal pain and jaundice. Computed tomography revealed gallstones, common bile duct calculus, and thrombus in the left main branch of the portal vein. A nasobiliary tube was inserted under endoscopic retrograde cholangiography. Cytology of the bile juice revealed many C. sinensis eggs. The abdominal pain and jaundice improved following choledocholithotomy and combination treatment with a chemotherapeutic agent and anti-coagulant. This case suggests that inflammation around the portal vein as a result of C. sinensis infection has the potential to evoke portal vein thrombosis. Such cases should be treated with both a chemotherapeutic agent and anti-coagulant therapy. In conclusion, the possibility of infection with C. sinensis should be considered in patients presenting with hyperbilirubinemia and portal vein thrombosis, particularly in East Asian populations.

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Bilirubin levels predict malignancy in patients with obstructive jaundice

Abstract: In patients with obstructive jaundice, bilirubin levels in isolation represent an important tool for discriminating between benign and malignant underlying causes.

Cited by 47 publications

References 17 publications

Pancreatobiliary Diseases Management by Endoscopic Ultrasonography/Endoscopic Retrograde Cholangiopancreatography Interface in Kurdistan Centre for Gastroenterology & Hepatology

Pancreatobiliary Diseases Management by Endoscopic Ultrasonography/Endoscopic Retrograde Cholangiopancreatography Interface in Kurdistan Centre for Gastroenterology & Hepatology

Novel score for prediction of malignant bile duct obstruction based on biochemical and clinical markers

Clonorchis sinensis ova in bile juice cytology from a patient with severe hyperbilirubinemia and portal vein thrombosis

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