Biliary atresia screening in Shenzhen: implementation and achievements

Abstract

ObjectiveTo elaborate on the implementation and achievements of a biliary atresia (BA) screening programme in Shenzhen.MethodsIn 2015, we partnered with the government in Shenzhen and attached the stool colour card (SCC) to the health handbook for mothers and children. These handbooks have been distributed through official channels to every pregnant woman in Shenzhen since 1 January 2015. A total of 118 patients diagnosed with BA at Shenzhen Children’s Hospital were enrolled and divided into two cohorts based on their date of diagnosis: cohort A before and cohort B after introduction of screening. The cohorts were compared to evaluate differences in age at diagnosis, jaundice-free rate, 2-year native liver survival rate and so on.ResultsAfter the implementation of the screening programme, the age at diagnosis decreased from 81±12 to 56±15 days old (p<0.05), the incidence of postoperative complications decreased from 58.8% to 52.6% (p<0.05), the jaundice-free rate increased from 47.1% to 54.4% (p<0.05), and the 2-year native liver survival rate increased from 44.4% to 52.6% (p<0.05). The percentage of patients who underwent surgery increased from 68.0% to 83.8% (p<0.05).ConclusionIn Shenzhen, our screening programme led to earlier diagnoses and better prognoses. The latter resulted in an increased willingness to undergo the Kasai procedure. Through a hospital and government collaboration, this programme exerted a considerable influence, and guardians observed benefits with only a small cost of implementation. Our results may eventually help promote the widespread use of the SCC across the whole country.

Population-based screening methods in biliary atresia: a systematic review and meta-analysis

“…Included studies were retrospective cohort studies (n=4),12–15 prospective cohort studies (n=12),6 7 16–25 cross-sectional studies (n=7),26–32 case–control studies (n=2)33 34 and cost–benefit analyses (n=2) 35 36. Two studies were conducted in the USA,22 27 two in Canada,7 25 seven in China,13 15 20 28 29 31 32 six in Japan,16 17 19 26 30 33 six in Taiwan6 12 14 18 21 23 and two in the UK 24 34. Two studies were cost-effectiveness analyses and so had no designated nation 35 36.…”

“…Data for the effect on screening on the resulting age of Kasai were available for eight studies: seven using SCC and one using conjugated bilirubin measurements (table 2). 6 12 13 17 18 21–23 33 All studies using SCC demonstrated a reduction in the age of Kasai, with the range of reduction being 8.4–25.0 days, and the average age at Kasai of 48.0–59.7 days after SCC.…”

“…Five studies explored BA-associated morbidity, hospital admission and mortality: four for SCC and one for conjugated bilirubin measurements 13 21 22 25 33. Screening with either SCC or conjugated bilirubin improved both overall and transplant-free survival among patients with BA.…”

Etiology of neonatal cholestasis after emerging molecular diagnostics

“…The stool color card as a screening test in China has helped to move up the diagnostic time of BA to the neonatal period (23). Early operation within two months of age helped to improve the overall prognosis (24).…”

Biliary Atresia in 2021: Epidemiology, Screening and Public Policy

“…National BA screening programs using an SCC have been introduced in Switzerland and Japan [36,49]. Small pilot studies with the SCC have been conducted in regions or municipalities in Brazil [50], Cairo, Egypt [51], Shenzen (China) [52], Northern Portugal [53], and Lower Saxony Germany [54]. However, to our knowledge, comprehensive feasibility and performance studies of the SCC in these locales have not yet been reported.…”