The effect of ursodeoxycholic acid in liver functional restoration of patients with obstructive jaundice after endoscopic treatment: a prospective, randomized, and controlled study

BACKGROUND

In patients with obstructive jaundice, multi-organ dysfunction may develop.

METHODS/DESIGN

This trial is a prospective, open-label, randomized, and controlled study with the objective to evaluate the effect of ursodeoxycholic acid in liver functional restoration in patients with obstructive jaundice after endoscopic treatment. The aim of this study is to evaluate the effect of ursodeoxycholic acid in liver functional restoration of patients with obstructive jaundice after endoscopic treatment. The hypothesis of this trial is that patients with obstructive jaundice, in which will be administered UDCA, in the early phase after endoscopic intervention will have better and faster functional restoration of the liver than patients in the control group.Patients with obstructive jaundice, randomly, will be divided into two groups: (A) test group in which will be administered ursodeoxycholic acid twenty-four hours after endoscopic procedure and will last fourteen days, and (B) control group.Serum-testing will include determination of bilirubin, alanine transaminase, aspartate transaminase, gama-glutamil transpeptidase, alkaline phosphatase, albumin, and cholesterol levels. These parameters will be determined one day prior endoscopic procedure, and on the third, fifth, seventh, tenth, twelfth and fourteenth days after endoscopic intervention.

DISCUSSION

This trial is a prospective, open-label, randomized, and controlled study to asses the effect of ursodeoxycholic acid in liver functional restoration of patients with obstructive jaundice in the early phase after endoscopic treatment.

Treatment of enterocutaneous fistula with total parenteral feeding in combination with octreotide: a case report

Introduction

The diagnosis and classification of fistulas based on anatomy, physiology and etiological criteria is the first important stage, conservative treatment consists on patient's stabilization. Finally, on complicated cases, when spontaneous closure fails, specific surgical approach should be applied.

Case presentation

A 50 years-old women patient underwent four surgical interventions from the bowel gangrene, caused from the superior mesenteric vein thrombosis consequences. After fourth surgical intervention, at eighth post-operative day, the enterocutaneous fistula developed. On 20-th day, after enterocutaneous fistula developed, together with TPN, we administered also octreotide (100 micrograms/8 hours), for 48 hours. The reduction of fistula output, after treatment of TPN in combination with octreotide, compare the treatment only with TPN, was not significant (p < 0, 05). The enterocutaneous fistula, developed after fourth operation, has been spontaneously closed after four months.

Conclusion

The fistula output, after treatment of TPN in combination with octreotide, compared with the treatment only with TPN, wasn't significant, in our case, (p < 0,05). We think that the optimum time for surgical treatment should not be based only on the period of time of conservative treatment, but other factors should be taken on consideration like: the pathology that has indicated the surgical treatment, the number of surgical interventions and period of time between these interventions.