title: [Clinical significance of white bile (bilirubin-free bile) in malignant bile duct obstruction].
abstract: OBJECTIVE
  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 <1.5 mg/dL and yellow 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.
authors.affiliation: Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
authors.forename: Jin Tae
authors.initials: JT
authors.lastname: Jung
authors.forename: Ho Gak
authors.initials: HG
authors.lastname: Kim
authors.forename: Jimin
authors.initials: J
authors.lastname: Han
authors.forename: Joong Goo
authors.initials: JG
authors.lastname: Kwon
authors.forename: Chang Hyeong
authors.initials: CH
authors.lastname: Lee
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Kim
mesh_terms: D000368:Aged; D001646:Bile / Q000737:chemistry* / Q000382:microbiology; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D001663:Bilirubin / Q000032:analysis; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D002779:Cholestasis / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D003627:Data Interpretation, Statistical; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016019:Survival Analysis
chemical_list: D001663:Bilirubin