Estimation of postoperative fat absorption using the 13C mixed-triglyceride breath test in children with choledochal cyst

Abstract

No previous studies have focused on postoperative fat malabsorption in children with choledochal cyst (CC) who undergo cyst excision and Roux-en-Y (RY) hepatico-jejunostomy (HJ), a combination of procedures that can lead to the non-physiological mixture of food and bile juice. To examine the effect of RYHJ with cholecystectomy on the fat absorption ability of children with CC, we estimated postoperative fat-absorption ability using the carbon 13-labeled mixed triglyceride (13C-MTG) breath test. Twelve postoperative children with CC and 12 normal control children were administered 13C-MTG orally and asked to give breath samples at six time points: once before the 13C-MTG ingestion and at five 60-min intervals postingestion. Fecal chymotrypsin activity and fecal fat excretion were also measured. The delta value of breath 13CO2 at 3, 4, and 5 h after administration and the 5-h cumulative breath 13CO2 were significantly lower in the CC children than in the controls. There were no significant differences in the fecal chymotrypsin activity or fecal fat excretion of the two groups. Conclusion. Occult fat malabsorption occurs in patients with CC after RYHJ, even in the absence of clinical symptoms or abnormal laboratory data.

European guideline on indications, performance and clinical impact of 13C‐breath tests in adult and pediatric patients: An EAGEN, ESNM, and ESPGHAN consensus, supported by EPC

“…In infants with cystic fibrosis, sensitivity of the 13 C‐MTGBT for diagnosis of steatorrhea was high, but specificity was low 142 . Thus, the test has been mainly, though not exclusively, 143,144 used to evaluate the efficacy of PERT in children with cystic fibrosis 145 …”

Short limb in biliary tract reconstruction: A retrospective study of living donor liver transplantation in children with biliary atresia

“…Because of the different growth rates between the intestine and the mesentery, the Roux limb can become twisted and obstructed. [12] In addition, bacterial overgrowth increases the loss of bile salts, resulting in impaired gut circulation and impaired absorption of fat and fat-soluble vitamins A, D, E, and K. [13,14] The reconstruction of RYHJ is one of the keys to the success of pediatric liver transplantation. In clinical practice, the length of the residual Roux limb after the Kasai operation is usually <40 cm, but the choledochojejunostomy is tension-free and the original limb can be reserved for choledochojejunostomy.…”

“…Because of the different growth rates between the intestine and the mesentery, the Roux limb can become twisted and obstructed. [ 12 ] In addition, bacterial overgrowth increases the loss of bile salts, resulting in impaired gut circulation and impaired absorption of fat and fat-soluble vitamins A, D, E, and K. [ 13 , 14 ]…”

A shorter loop in Roux-Y hepatojejunostomy reconstruction for choledochal cysts is equally effective: preliminary results of a prospective randomized study

“…Ectopic gut pacemaker activity may also cause antiperistalsis [3], leading to ascending cholangitis [4]. In addition, bacterial overgrowth increases bile salt loss and may result in steatorrhoea [7] with the consequences of malabsorption of fat [5] and fat-soluble vitamins A, D, E, and K. On the other hand, the secretive surface area of gastric inhibitory polypeptide in the remaining functional jejunal segment is remarkably decreased when a long segment of proximal jejunum is used for the Roux loop. Hyposecretion of gastric inhibitory polypeptide induces hypersecretion of gastric acid, which, in turn, may result in duodenal ulcer [8].…”

“…obstruction [2], bile stasis [3], and bacterial overgrowth and associated ascending cholangitis [4], stone formation, and malabsorption of fat and fat-soluble vitamins [5]. We compared the outcome of a shorter Roux loop with the standard loop length in Roux-Y hepatojejunostomy (RYHJ) reconstruction in children with CDC.…”