Total bile acid better reflects the early biochemical biliary drainage response after endoscopic retrograde cholangiopancreatography

Figure 1 Study flowchart of cohort derivation. The flowchart summarizes patient screening, exclusions, and final analytic cohorts for the main analysis, trajectory analysis, and cross-marker comparison. ERCP: Endoscopic retrograde cholangiopancreatography; TBA: Total bile acid; Dbil: Direct bilirubin; Tbil: Total bilirubin.

Figure 2 Early postoperative changes in total bile acid, direct bilirubin, and total bilirubin after therapeutic biliary endoscopic retrograde cholangiopancreatography. A: Median trajectories of total bile acid, direct bilirubin, and total bilirubin at baseline, within 24 hours after endoscopic retrograde cholangiopancreatography (ERCP), and within 5 days after endoscopic retrograde cholangiopancreatography; B: Relative decline from baseline at 24 hours after ERCP; C: Relative decline from baseline within 5 d after ERCP; D: Cross-marker comparison using the decline index [-log (postoperative/baseline ratio)]. Higher values indicate greater postoperative decline from baseline. Box plots show medians and interquartile ranges. ^dP < 0.0001; IQR: Interquartile range; TBA: Total bile acid; Dbil: Direct bilirubin; Tbil: Total bilirubin.

Figure 3 Marker trajectories stratified by main diagnosis. A: Total bilirubin trajectories according to diagnosis group; B: Direct bilirubin trajectories according to diagnosis group; C: Total bile acid trajectories according to diagnosis group. Median values with interquartile ranges are shown at baseline, within 24 hours after endoscopic retrograde cholangiopancreatography, and within 5 days after endoscopic retrograde cholangiopancreatography. IQR: Interquartile range.

Figure 4 Marker trajectories stratified by drainage strategy. A: Total bilirubin trajectories according to drainage strategy; B: Direct bilirubin trajectories according to drainage strategy; C: Total bile acid trajectories according to drainage strategy. Median values with interquartile ranges are shown at baseline, within 24 hours after endoscopic retrograde cholangiopancreatography, and within 5 days after endoscopic retrograde cholangiopancreatography. IQR: Interquartile range; ENBD: Endoscopic nasobiliary drainage.

Figure 5 Exploratory comparison of total bile acid with gamma-glutamyl transferase and alkaline phosphatase. A: Post-endoscopic retrograde cholangiopancreatography (ERCP) trajectory of gamma-glutamyl transferase; B: Post-ERCP trajectory of alkaline phosphatase; C: Relative decline of total bile acid, gamma-glutamyl transferase, and alkaline phosphatase at 24 hours after ERCP; D: Relative decline of total bile acid, gamma-glutamyl transferase, and alkaline phosphatase within 5 days after ERCP. Median values with interquartile ranges or box plots are shown as appropriate. IQR: Interquartile range; TBA: Total bile acid; GGT: Gamma-glutamyl transferase; ALP: Alkaline phosphatase.

Figure 6 Multivariable predictors of early biochemical drainage response. Forest plot showing odds ratios and 95% confidence intervals from the final multivariable logistic regression model for early biochemical drainage response after ERCP. ERCP: Endoscopic retrograde cholangiopancreatography; ENBD: Endoscopic nasobiliary drainage; Tbil: Total bilirubin; ALP: Alkaline phosphatase; GGT: Gamma-glutamyl transferase; WBC: white blood cell count.