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 less than 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 less than 0.05), an increase in temperature (p less than 0.01), and an increase in creatinine concentration (p less than 0.05) before and after biliary manipulation. The presence of infected bile and the preprocedure bilirubin level predicted development of endotoxemia.