Endotoxemia during percutaneous manipulation of the obstructed biliary tree

Fourteen patients undergoing percutaneous biliary manipulation were studied on 21 occasions. Using a chromogenic limulus-based assay technique, peripheral endotoxin concentration prior to the procedure was found to be 6.1 ± 9 pg/ml, increasing to 30.7 ± 26 pg/ml after the procedure (p < 0.001). Fourteen of 21 bile cultures and only 1 of 21 blood cultures drawn during the procedure were positive for bacterial growth. There was a clinically modest but statistically significant decrease in blood pressure (p < 0.05), an increase in temperature (p < 0.01), and an increase in creatinine concentration (p < 0.05) before and after biliary manipulation. The presence of infected bile and the preprocedure bilirubin level predicted development of endotoxemia.