Does preoperative biliary drainage allow an improvement of nutritional status in the jaundiced patient?

Twelve patients with malignant obstructive jaundice were studied during preoperative percutaneous biliary drainage. Nutritional assessment was performed before drainage. Weight, mid-arm muscle circumference, total body potassium, body fat estimation, delayed hypersensitivity skin testing, serum albumin and thyroxine- binding prealbumin were measured. During drainage, all patients were given at least 3, 000 kcal/day by the oral, enteral or parenteral route. Drainage was carried out for a mean of 26 days (range 10-45 days). Nutritional assessment was repeated just before operation. During drainage, 6 of 12 patients developed infected bile and 1 of these patients died. All but 1 of the patients with sterile bile improved their prealbumin levels during drainage and they had fewer postoperative complications. Most patients with infected bile did not show an improvement in prealbumin. These results suggest that, during percutaneous biliary drainage, improvements in nutritional status can be achieved if the bile remains sterile. © 1987 S. Karger AG, Basel.