BILIARY ATRESIA: evaluation on two distinct periods at a reference pediatric service

Abstract

-Context -Biliary atresia is a progressive, idiopathic, fibro-obliterative disease of the extrahepatic biliary tree that presents with biliary obstruction exclusively in the neonatal period. Objective -To assess the differences regarding age at referral, age at surgery, duration of propaedeutics and waiting time for surgery between two groups of infants in different periods. MethodsRetrospective study of infants diagnosed with biliary atresia on two periods: 1983-1993 and 1998-2011. Results -Biliary atresia was diagnosed in 129 infants, being 48 in casuistic I and 81 in casuistic II. The median age at admission was 94 and 60 days, respectively (P = 0.0001). On evaluating patients who had undergone portoenterostomy before 120 days of age, no difference was observed regarding the duration of propaedeutics or waiting time for surgery (P = 0.15), but difference was found when comparing the age at surgery (P = 0.002). Among those infants with no biliary flow and without liver transplantation or death after 18 post-operative months, the estimated probability of survival was 44.6% and 38.7% in casuistics I and II, respectively. In casuistic I, all infants who showed biliary flow were alive during the observation period and, in casuistic II, 80.3% were alive after 7 years of follow-up. Conclusions -Even though patients were admitted and treated earlier, it is clear that surgery could be done sooner. Delay in referral and timely propaedeutics were the main contributors.

Stool color card use for early detection of biliary atresia

“…In our study, we observed that the inclusion of the SCC to the NHC had no impact on the reference age, the age of diagnosis, or the age of the surgery in patients with BA. Unlike our results, with the incorporation of SCC in other countries, an increase in detection before 60 days of life has been demonstrated, from 72.5% to 97% of cases (p = 0.004) [19][20][21][22] . The same happened in another more recent study, in which after the implementation of the SCC in a cohort of 349 patients, Kasai surgery was performed in the majority at 59 days, and only in 20%, this surgery was carried out after day 90 [8][9][10][11][12][13] .…”

“…In several countries with a high incidence of BA, such as Taiwan and Japan [14][15][16][17][18][19] , a stool color card (SCC) for the screening of patients with suspicion of BA was created since the 90s to decrease the detection age of children with BA. The original card was described by Matsui and Dodoriki 20 and initially included eight colors marked from 1 to 4 as an abnormal acholic stool.…”

Outcome of biliary atresia among Saudi children: A tertiary care center experience

“…Most of the literature on the outcome of KPE originated from Europe, North America, and Far East of Asia [Table 2]. [1234567891014151617]. Although late referral of BA cases is a problem all over the world, it is more pronounced in Saudi Arabia.…”

Uso de la tarjeta colorimétrica visual para la detección oportuna de atresia de vías biliares

“…En contraste, los casos no detectados a menor tiempo, o en los que no hay adecuado restablecimiento del flujo biliar (bilirrubina total >2 mg/dl) a pesar de la cirugía de Kasai, desarrollarán cirrosis biliar y complicaciones a corto plazo. Desafortunadamente, la mayoría de los pacientes en esta situación fallecerán antes de los 2 años de edad, a menos de que se realice un trasplante hepático 7-13. A fin de disminuir la edad para detectar niños con AVB, en diversos países con alta incidencia de AVB, como Taiwán y Japón [14][15][16][17][18][19] , desde la década de 1990 se cuenta con una tarjeta colorimétrica visual (TCV) para la detección de pacientes con sospecha de AVB. La tarjeta original fue descrita por Matsui y Dodoriki 20 e inicialmente incluía ocho colores marcados de 1 al 4 como evacuaciones anormales acólicas.…”