Jackson Pratt drain fluid-to-serum bilirubin concentration ratio for the diagnosis of bile leaks

Background: Jackson Pratt (JP) drain fluid bilirubin levels may be assayed in the evaluation of possible bile leaks. Although fluid color and bilirubin level may prompt additional evaluation, there are no reference data available. Objective: To assess the JP drain fluid-to-serum bilirubin ratio in patients with documented bile leaks. Design: Prospective case series. Setting: Tertiary referral center. Methods: Patients referred for ERCP for the management Of documented bile leaks with a JP drain in place were included. Demographic data, bile leak etiology, and serum bilirubin levels were recorded? drain fluid Was sent for color evaluation and bilirubin concenteration. Control subjects included both patients after nonbiliary surgery with JP drain in place and medical patients with ascites undergoing paracentesis. Results: JP drain fluid-to-serum bilirubin concenteration and fluid color evaluation was performed on 23 patients with documented bile leaks by ERCP and compared with 26 controls (16 surgical and 10 medical). The,JP drain fluid/ascites-to-serum bilirubin ratio was significantly higher in those with bile leaks (mean ratio 45.6) conipared with combined controls (mean ratio 0.9). Use of a cutoff drain fluid-to-serum bilirubin ratio of 5 would be 100% sensitive and specific for the prediction of,I bile leak ill the selected control group. There was overlap ill fluid color evaluation between the groups. Limitations: Coritrols did not include those with suspectecl bile leaks and negative technetium 99m-HIDA scintigrapt-ly or ERCI) findiigs. Conclusions: JP drain fluid-to-serum bilirubin concenteration ratio greater that 5 seems to be highly sensitive and Specific for the detection of a bile leak. Used along with clinical criteria, this ratio could be used to select patients to proceect clirectly to ERCP (Gast roit-I test Enclosc 2010;71:99-'104.)