Wang Y, Xi JW, Zhang WS, Wu QL, Liu F, Xie YL, Cao ZL. Internal vs oral bile reinfusion for hepatic recovery after percutaneous transhepatic cholangiodrainage. World J Gastrointest Surg 2026; 18(9): 118865 [DOI: 10.4240/wjgs.118865]
Corresponding Author of This Article
Zhi-Li Cao, Associate Chief Physician, Department of Infectious diseases, The Second Affiliated Hospital of Hebei North University, No. 92 Qingyuan Road, Xuanhua District, Zhangjiakou 075100, Hebei Province, China. efyczl789@163.com
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Wang Y, Xi JW, Zhang WS, Wu QL, Liu F, Xie YL, Cao ZL. Internal vs oral bile reinfusion for hepatic recovery after percutaneous transhepatic cholangiodrainage. World J Gastrointest Surg 2026; 18(9): 118865 [DOI: 10.4240/wjgs.118865]
World J Gastrointest Surg. Sep 27, 2026; 18(9): 118865 Published online Sep 27, 2026. doi: 10.4240/wjgs.118865
Internal vs oral bile reinfusion for hepatic recovery after percutaneous transhepatic cholangiodrainage
Yan Wang, Jiang-Wei Xi, Wen-Shuang Zhang, Qing-Lei Wu, Fang Liu, Ya-Li Xie, Zhi-Li Cao
Yan Wang, Wen-Shuang Zhang, Qing-Lei Wu, Fang Liu, Zhi-Li Cao, Department of Infectious Diseases, The Second Affiliated Hospital of Hebei North University, Zhangjiakou 075100, Hebei Province, China
Jiang-Wei Xi, Department of General Surgery, The Second Affiliated Hospital of Hebei North University, Zhangjiakou 075100, Hebei Province, China
Ya-Li Xie, Department of Outpatient, The Second Affiliated Hospital of Hebei North University, Zhangjiakou 075100, Hebei Province, China
Co-first authors: Yan Wang and Jiang-Wei Xi.
Author contributions: Wang Y drafted the initial manuscript; Wang Y and Cao ZL conceived and designed the study; Xi JW and Zhang WS performed patient enrollment and data collection; Wu QL and Liu F conducted the statistical analyses and interpretation; Xie YL contributed to patient follow-up and quality of life assessments; All authors critically reviewed and revised the manuscript for important intellectual content and approved the final version for publication. Wang Y and Xi JW contributed equally to this work as co-first authors.
AI contribution statement: The authors confirm that no AI tools were used in any stage of this study, including data collection, statistical analysis, manuscript writing, or figure preparation. All intellectual contributions were made solely by the human authors listed.
Supported by the Zhangjiakou Science and Technology Research and Development Program, No. 2121093D.
Institutional review board statement: This study was reviewed and approved by the Medical Ethics Committee of the Second Affiliated Hospital of Hebei North University (Approval No. 2024-IRB-095).
Informed consent statement: The requirement for written informed consent was waived by the Medical Ethics Committee of the Second Affiliated Hospital of Hebei North University, as this was a retrospective study based on anonymized data obtained from routine clinical records and involved no additional risk to patients.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: De-identified participant data are available from the corresponding author upon reasonable request.
Corresponding author: Zhi-Li Cao, Associate Chief Physician, Department of Infectious diseases, The Second Affiliated Hospital of Hebei North University, No. 92 Qingyuan Road, Xuanhua District, Zhangjiakou 075100, Hebei Province, China. efyczl789@163.com
Received: March 10, 2026 Revised: April 21, 2026 Accepted: August 25, 2026 Published online: September 27, 2026 Processing time: 188 Days and 23.2 Hours
Abstract
BACKGROUND
Percutaneous transhepatic cholangiodrainage (PTCD) is the gold standard for palliative management of malignant obstructive jaundice when endoscopic attempts fail or are contraindicated. However, long-term bile drainage externally produces a significant amount of biliary loss that can affect recovery of liver function and nutrition. Bile reinfusion is a promising approach for long-term maintenance of enterohepatic circulation; however, only a few studies have systematically compared different methods of bile reinfusion.
AIM
To explore whether hepatic function recovery after PTCD is better with internal than external bile reinfusion in patients with malignant obstructive jaundice.
METHODS
This retrospective study included a total of 100 patients with malignant obstructive jaundice treated with PTCD from January 2020 to December 2023. Patients were assigned to be treated with internal bile reinfusion through drainage tube (observation group, n = 55) or oral bile reinfusion (control group, n = 45). Between groups, baseline characteristics were similar. The primary outcomes were hepatic function parameters (serum total bilirubin, direct bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase and albumin) measured at baseline and then 1 week, 2 weeks, and 4 weeks after the reinfusion. Secondary outcomes included the nutritional indices (prealbumin, hemoglobin and body weight), gastrointestinal symptoms, quality of life scores and safety data.
RESULTS
All outcomes were found to be significantly better in the observation group. At 4 weeks after reinfusion, total bilirubin decreased more significantly in the observation group (42.5 ± 12.3 μmol/L vs 68.7 ± 18.5 μmol/L; P < 0.001) and direct bilirubin (28.3 ± 8.5 μmol/L vs 45.2 ± 12.7 μmol/L; P < 0.001). At the end of intervention, serum albumin levels were more improved (38.5 ± 4.2 g/L vs 34.2 ± 5.1 g/L; P < 0.001), with normal serum albumin achieved by 78.2% compared with 46.7% in controls (P = 0.001). The liver transaminases (alanine aminotransferase: 38.5 ± 12.3 U/L vs 56.8 ± 18.5 U/L; P < 0.001; aspartate aminotransferase: 42.3 ± 14.5 U/L vs 62.5 ± 20.3 U/L; P < 0.001) of the patients in observation group were significantly recovered faster than those of control group respectively. Cholestatic enzymes normalized more quickly (alkaline phosphatase: 185.3 ± 42.5 U/L vs 248.7 ± 58.3 U/L; P < 0.001; gamma-glutamyl transferase: 125.8 ± 35.2 U/L vs 178.5 ± 48.7 U/L; P < 0.001). Prealbumin level significantly improved (285.5 ± 45.3 mg/L vs 215.8 ± 52.7 mg/L; P < 0.001), body weight loss ameliorated (2.3 ± 1.5 kg vs 5.8 ± 2.3 kg; P < 0.001) and quality of life scores increased (78.5 ± 9.2 vs 62.3 ± 11.5; P < 0∙001). The safety profile was similar between groups for catheter-related complications (12.7% vs 13.3%; P = 0.926). Multivariable analysis showed that internal bile reinfusion was independently associated with the recovery of good hepatic function after PTCD (adjusted odds ratio = 9.25, 95% confidence interval: 3.58-23.91; P < 0.001).
CONCLUSION
Internal bile reinfusion through the drainage tube markedly improves hepatic function recovery, shortens the time of total bilirubin normalization, enhances nutritional status, and significantly raises quality of life in patients with malignant obstructive jaundice patients after PTCD. It is a safe and effective option for postoperative bile therapy and may better preserve enterohepatic circulation than oral reinfusion.
Core Tip: Malignant obstructive jaundice treated with percutaneous transhepatic cholangiodrainage often results in prolonged bile loss and delayed hepatic recovery. This retrospective study demonstrates that internal bile reinfusion via the drainage catheter restores enterohepatic circulation more effectively than oral bile reinfusion. Internal reinfusion significantly accelerates bilirubin normalization, improves hepatic synthetic and nutritional status, reduces gastrointestinal symptoms, and enhances quality of life without increasing complications. Internal bile reinfusion represents a safe, practical, and superior postoperative bile management strategy after percutaneous transhepatic cholangiodrainage.
