Extra-hepatic biliary atresia: diagnostic methods

Abstract

Objective: to emphasize the importance of precocious diagnosis of extrahepatic biliary atresia and its direct relationship with the surgical re-establishment of the biliary flow before the second month of life. To discuss several complementary methods with the aim of selecting the ones that present better evidence, and avoiding delays in diagnosis and worse prognostic. Source of data: bibliographical researching regarding the period of 1985-2001, in Medline and MdConsult, using the following key words: neo-natal cholestasis; extrahepatic biliary atresia; neo-natal hepatitis. National and foreign articles were also selected based on the bibliography of consulted publications, and when necessary, for better understanding of the theme, opinions emitted in theses and textbooks were referred. Summary of the findings: the revision of the consulted bibliography led to the assumption that early diagnosis of EHBA and surgical treatment to reestablish the biliary flow up to 60 days of life are fundamental in order to achieve good results. Among several complementary methods of diagnosis, cholangiography by MR, US and the hepatic biopsy are the ones that provide the largest success indexes. Conclusions: the referring of patients bearers of EHBA to centers of references in Brazil, is still made tardily, probably due to lack of enlightenment of the doctors of primary attention, allied to bureaucratic and technological difficulties. The experience in England in relation to the "Yellow Alert" program, allowed that the number of children referred to surgical treatment before the 60 days of life increased significantly. Among the complementary methods, the MR cholangiography, ultrasonography and hepatic biopsy should be used, depending on the technological resources of the diagnosis units.

Value of hepatic subcapsular flow by color Doppler ultrasonography in the diagnosis of biliary atresia

“…In accordance with these results, Rastogi et al 10 reported that portal tract changes including ductular proliferation, bile duct and ductular bile plugs, and portal fibrosis were significantly more frequent in BA compared with other disorders causing NC, multinucleated giant hepatocytes were more frequent in NH (80%) in comparison with BA (21%), and more than 50% of the BA cases showed moderate to marked portal fibrosis, whereas only two cases of NH had moderate expansion of portal areas by fibrosis. 10 Similar findings were reported by others 17,21,22 concluding that ductular proliferation had the best performance among the liver biopsy criteria for diagnosis of BA.…”

Urinary urobilinogen in biliary atresia: A missed, simple and cheap diagnostic test

“…As reported before in our studies and in the studies of others, the present study showed that different clinical, laboratory, ultrasonographic and histopathological parameters have significant diagnostic values for differentiating BA from non‐BA cholestatic disorders with different specificities and sensitivities for each parameter. No single test showed 100% sensitivity and specificity and it is well documented that the summation of different parameters will give more accuracy in diagnosis, as we reported before in our recently developed BA score …”

Avaliação da atenção em saúde em pacientes com atresia de vias biliares em um hospital terciário no Nordeste do Brasil

“…The surgical procedures mostly took place without serious complications, but due to the progress of the disease, most of the children had subsequent indication of transplantation or died. Regarding the ideal age for surgery, the five patients who underwent Kasai before 60 days of life had outcomes similar to the literature, with three without indication for transplantation (two currently anicteric), one transplanted and the other died 5,13,23,24 .…”