Intraoperative hepatic subcapsular spider-like telangiectasia sign for the definitive diagnosis of biliary atresia

Abstract

Objective: To evaluate the accuracy of intraoperative hepatic subcapsular spider-like telangiectasia (HSST) sign for differentiating biliary atresia (BA) from other causes of hepatic cholestasis.Methods: The data of 69 patients with jaundice treated from January 2018 to December 2021 were retrospectively analyzed. Based on intraoperative cholangiography (IOC), the patients were divided into two groups: BA group (n = 49) and non-BA group (n = 20). The biochemistry tests, liver ultrasound, liver stiffness and HSST sign of the two groups were compared.Results: The incidence of abnormal gallbladder, elevated γ-glutamyl transpeptidase (γ-GGT) >182.0U/L and abnormal liver stiffness (>6.4kPa) in BA group were significantly higher than those in non-BA group (P < 0.001). The HSST sign was present in all BA patients and not found in non-BA group. The area under receiver operating curve of direct bilirubin, γ-GGT, abnormal gallbladder, liver stiffness value and HSST sign were 0.53, 0.84, 0.78, 0.96, and 1.00, respectively. The sensitivity, specificity, PPV and NPV of HSST sign in the diagnosis of BA were all 100%.Conclusion: Presence of HSST sign on diagnostic laparoscopy or laparotomy is highly suggestive of BA. If the HSST sign is present on laparoscopy, then IOC can be avoided.