Jaundice After Biliary Dilation: What to Expect - Gastroenterology and Hepatology

Biliary dilation causing jaundice?

Dear Dr.
Hsu,
My husband recently underwent an endoscopic retrograde cholangiopancreatography (ERCP) for biliary stricture.
After the first procedure, he experienced biliary obstruction due to an improper size of the stent, which led to symptoms such as jaundice, generalized itching, abdominal swelling, and fatigue.
Once this was discovered, he was immediately taken to the hospital for a repeat ERCP, where the doctor placed a larger stent.
His condition after the second procedure is better than after the first.
The doctor mentioned that the jaundice would take about a week to resolve, and it has now been four days.
Although he is feeling better than after the first procedure, he still experiences some itching (though not as severe as before) and fatigue.
His skin and sclera remain yellow, and his urine is dark brown.
Is this normal? Is this a sign of improvement? The doctor only prescribed antibiotics after the procedure, and we are quite worried about my husband's condition.
Please help us.
Thank you for your assistance.

Miss Wang, 20~29 year old female. Ask Date: 2005/08/20

Dr. Xu Jinchuan reply Gastroenterology and Hepatology

Hello! Your husband is experiencing bile duct narrowing, which can lead to bile retention and inflammation.
It is necessary to use drainage to alleviate this condition, and the letter mentioned that ERCP is the treatment method.
Although a larger drainage tube was successfully placed during the second procedure, the components of bile have already accumulated in the skin, so improvement may not be immediate.
However, what is your husband's current bilirubin level? GPT? Without your husband's medical history, it is difficult to assess his condition online.
You may want to consult his attending physician for more information.
Since there was previous inflammation, it is still necessary to use antibiotics to control the infection.

Reply Date: 2005/08/20

More Info

Understanding jaundice after biliary dilation can be quite concerning, especially after a procedure like endoscopic retrograde cholangiopancreatography (ERCP) aimed at alleviating biliary obstruction. Your husband's experience with jaundice, itching, abdominal swelling, and fatigue following the procedure is not uncommon, and it's important to understand what to expect during recovery.

Jaundice occurs when there is an accumulation of bilirubin in the blood, which can happen due to various reasons, including bile duct obstruction. In your husband's case, the initial ERCP may have resulted in a temporary blockage, leading to the symptoms you described. The subsequent placement of a larger stent was a necessary step to ensure proper bile flow and alleviate the obstruction.

After the second ERCP, it is expected that the bilirubin levels will begin to decrease, but this process can take time. The fact that your husband is experiencing some improvement—such as less severe itching and overall better condition—is a positive sign. However, the persistence of jaundice (yellowing of the skin and eyes) and dark urine indicates that the bilirubin levels may still be elevated, which is not unusual in the early days following such a procedure.

Typically, bilirubin levels can take about one to two weeks to normalize after successful biliary drainage, depending on the severity of the obstruction and the individual’s overall health. The timeline can vary significantly based on factors such as the extent of the initial blockage, the patient's liver function, and any underlying liver conditions.
The symptoms of fatigue and itching can also linger for a while as the body adjusts and recovers from the procedure. Itching, in particular, can be a result of elevated bile acids in the bloodstream, which may take time to resolve even after the obstruction is relieved.
In terms of management, it is crucial to monitor your husband's symptoms closely. If he experiences worsening jaundice, increased abdominal pain, fever, or any new concerning symptoms, it is essential to seek immediate medical attention. The antibiotics prescribed are likely aimed at preventing or treating any potential infection, which can be a risk following biliary procedures.

It's also important to maintain open communication with your healthcare team. If you have concerns about your husband's recovery or the management of his symptoms, do not hesitate to reach out to his doctor for further clarification or additional interventions. They may consider further tests, such as blood tests to monitor liver function and bilirubin levels, or imaging studies to ensure that the stent is functioning properly and that there are no other complications.

In summary, while your husband's symptoms are concerning, they can be part of the normal recovery process following biliary dilation. Monitoring his condition closely and maintaining communication with his healthcare providers will be key in ensuring a smooth recovery. With time, it is expected that his jaundice will improve, and he will start to feel better as his liver function normalizes.

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