Abstract
Background and study aims White bile is defined as a colorless fluid occasionally found in the biliary tract
of patients with bile duct obstruction. Its significance is not clearly established.
Our objective was to analyze the prognostic value of white bile in a series of patients
with biliary obstruction due to biliary or pancreatic cancer.
Patients and methods The study was conducted on a series of consecutive patients with malignant obstructive
jaundice. They all underwent endoscopic retrograde cholangiopancreatography with collection
of bile and biliary stent insertion. White bile was defined as bile duct fluid with
bilirubin level < 20 µmol/L. Univariate and multivariate analyses were performed to
identify variables associated with overall survival (OS).
Results Seventy-three patients were included (32 pancreatic cancers, 41 bile duct cancers).
Thirty-nine (53.4 %) had white bile. The mean bile duct bilirubin level in this group
was 4.2 ± 5.9 µmol/L vs 991 ± 1039 µmol/L in patients with colored bile (P < 0.0001).
In the group of 54 patients not eligible for surgery, the multivariate analysis demonstrated
an association between the presence of white bile and reduced OS (HR 2.3, 95 %CI 1.1–4.7;
P = 0.02). Other factors independently associated with OS were metastatic extension
(HR 2.8, 95 %CI 1.4–5.7) and serum total bilirubin (HR 1.003, 95 %CI 1.001–1.006).
There was a significant inverse correlation between serum and bile duct bilirubin
levels (r = –0.43, P = 0.0001).
Conclusion White bile in patients with inoperable malignant biliary obstruction is an independent
factor of poor survival.
