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

doi:10.3748/wjg.123951

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Jan 14, 2027; 33(2): 123951
Published online Jan 14, 2027. doi: 10.3748/wjg.123951

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

Guo-Lin Liao, Hai-Xing Wei, Jian-Fu Qin, Fei Qin, Jie Wang, Shi-Quan Liu, Jie-An Huang, Meng-Bin Qin

Guo-Lin Liao, Hai-Xing Wei, Jian-Fu Qin, Fei Qin, Jie Wang, Shi-Quan Liu, Jie-An Huang, Meng-Bin Qin, Department of Gastroenterology, The Second Affiliated Hospital of Guangxi Medical University, Nanning 530007, Guangxi Zhuang Autonomous Region, China

Co-corresponding authors: Jie-An Huang and Meng-Bin Qin.

Author contributions: Qin MB and Huang JA conceived and designed the study, critically revised the manuscript for important intellectual content, and they contributed equally to this manuscript as co-corresponding authors; Wei HX, Qin JF, Qin F, Wang J, and Liu SQ contributed to data acquisition, data curation, and interpretation of the data; Qin MB performed the clinical review and supervised the study; Liao GL and Wang J conducted the statistical analysis; Liao GL drafted the manuscript. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work.

AI contribution statement: ChatGPT was used only to draft and troubleshoot R code for analysis and figure preparation, not to generate manuscript text, interpretations, or conclusions. ChatGPT was used solely to assist with drafting and troubleshooting R code, all statistical analyses were conducted, and all figures were generated, by the authors using R software. No figure or image was generated by artificial intelligence. All code, analyses, figures, and outputs were independently reviewed and verified by the authors.

Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Second Affiliated Hospital of Guangxi Medical University, approval No. 2018-KYL (003).

Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: No additional data are available.

Corresponding author: Meng-Bin Qin, MD, Professor, Deputy Director, Department of Gastroenterology, The Second Affiliated Hospital of Guangxi Medical University, No. 166 Daxuedong Road, Nanning 530007, Guangxi Zhuang Autonomous Region, China. dr.mmbin@hotmail.com

Received: June 3, 2026
Revised: June 24, 2026
Accepted: July 17, 2026
Published online: January 14, 2027
Processing time: 158 Days and 0.3 Hours

Abstract

BACKGROUND

Currently, early assessment of the biliary drainage response after therapeutic biliary endoscopic retrograde cholangiopancreatography (ERCP) commonly relies on bilirubin-based markers, but these may not fully reflect the earliest postoperative biochemical improvement. We hypothesized that the total bile acid (TBA) level may provide an earlier and more sensitive signal of biochemical recovery after biliary drainage.

AIM

To compare the early postoperative trajectories of TBA, bilirubin, and cholestatic enzymes after therapeutic biliary ERCP.

METHODS

This single-center retrospective cohort study included adults undergoing therapeutic biliary ERCP. Laboratory values were assessed at baseline within 24 hours before ERCP, at the first postoperative test within 24 hours, and at the second postoperative test within 5 days. Baseline comparisons, logistic regression, generalized estimating equations, paired within-patient comparisons, and unified longitudinal models were used to evaluate whether TBA served as an earlier and more sensitive biochemical indicator of drainage response than bilirubin-based markers after therapeutic ERCP.

RESULTS

The main analytic cohort comprised 896 patients, of whom 278 achieved an early biochemical drainage response while 618 did not. TBA showed the most pronounced postoperative decline, while the decreases in direct bilirubin and total bilirubin occurred more slowly. Also, in the 836 patients with complete three-time-point measurements, the relative decline in TBA was significantly greater than that of direct bilirubin and total bilirubin at both 24 hours and within 5 days postoperatively. Exploratory analyses further showed that although the levels of gamma-glutamyl transferase and alkaline phosphatase also declined significantly after drainage, their early relative declines remained significantly smaller than that of TBA.

CONCLUSION

TBA declines earlier and more markedly than bilirubin-based and conventional cholestatic markers after biliary drainage, supporting its use as an adjunctive early biochemical indicator after therapeutic biliary ERCP.

Keywords: Total bile acid; Bilirubin; Biliary drainage; Endoscopic retrograde cholangiopancreatography; Cholestasis; Postoperative monitoring

Core Tip: Bilirubin-based markers are commonly used to assess the biliary drainage response after therapeutic endoscopic retrograde cholangiopancreatography, but their early postoperative changes may be limited. In this real-world cohort, total bile acid (TBA) declined earlier and more markedly than direct and total bilirubin. Although gamma-glutamyl transferase and alkaline phosphatase also declined after drainage, their early changes were smaller than those of TBA. These findings support TBA as a responsive adjunctive marker of early biochemical recovery after biliary drainage.