[The immune changes in the patient with obstructive jaundice: their onset and reversibility after drainage]

Several clinical and experimental studies have demonstrated that the high incidence of septic complications and the high mortality of surgery and invasive diagnostic and therapeutic procedures (ERCP and PTC) in obstructive jaundiced patients are mostly secondary to immune impairment (deficit of Kupffer's cells phagocytic activity and of cell-mediated immunity). The fundamental role of endotoxaemia, that's tightly related to stopped defluxion of biliary salts into the bowel, with bacterial flora increase and secondary passage of germs and toxins into portal and systemic circulation, has recently been demonstrated in the pathogenesis of the main homeostatic alterations in cholestasis (immunodeficiency, disorders of coagulation and renal functionality). This pathogenetic hypothesis explains not only high morbidity and mortality rates, but also the failures of external biliary drainage. The only treatment able to oppose endotoxaemia is internal biliary drainage, endoscopic or percutaneous. These techniques allow the defluxion of biliary salts into the bowel and a relatively quick restore of homeostasis. The authors after having treated high-risk jaundiced patients with internal endoscopic biliary drainage and surgical treatment (after 20-30 days), report excellent results.