Investigation into multi-centre diagnosis and treatment strategies of biliary atresia in mainland China

Zheng, Qipeng; Zhang, Shujian; Ge, Liang; Jia, Jinfu; Gou, Qingyun; Zhao, Jinfeng; Zhan, Jianghua

doi:10.1007/s00383-020-04679-z

Cited by 8 publications

(2 citation statements)

References 23 publications

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“…The second strategy − as suggested by some authors to reduce the incidence of ascending cholangitis in biliary atresia − was the construction of a spur valve to prevent re ux of gastrointestinal secretions into the Roux-and-Y ascending limb. [21] The nal strategy is to fashion the HJ anastomosis very close to the blind pouch of the jejunal limb to avoid anastomotic stricture and/or a redundant blind loop that can lead to bile stasis and the onset of repeated cholangitis of the IHBD that leads to intrahepatic lithiasis. [22] [23] [24] Chronic in ammation of the bile duct is the high-risk factor for carcinogenesis.…”

Section: Discussionmentioning

confidence: 99%

Long-term Outcome for Children Undergoing Open Hepatico-jejunostomy for Choledochal Malformations: a 43-year Single-center Experience

Stern,

Boroni,

Parolini

et al. 2023

Preprint

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Purpose To report on our 43-year single-center experience with children operated on for Choledochal Malformations (CMs), focusing on long term results and quality of life (QoL). Materials and Methods All consecutive pediatric patients with CMs who underwent surgical treatment at our center between October 1980 and December 2022 were enrolled in this retrospective study. We focused on long-term postoperative complications (POCs), considered to be complications arising at least 5 years after surgery. We analyzed QoL status once patients reached adulthood, comparing the results with a control group of the same age and sex. Results 113 patients underwent open excision of CMs with a Roux-en-Y hepaticojejunostomy (HJ). The median follow-up was 8.95 years (IQR: 3.74–24.41). Major long-term POCs occurred in six patients (8.9%), with a median presentation of 11 years after surgery. The oldest patient is currently 51. No cases of biliary malignancy were detected. The QoL of our patients was comparable with the control group. Conclusion Our experience suggests that open complete excision of CMs with HJ achieves excellent results in terms of long-term postoperative outcomes. However, since the most severe complications can occur many years after surgery, international cooperation is advisable to define a precise transitional care follow-up protocol.

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Section: Discussionmentioning

confidence: 99%

Long-term Outcome for Children Undergoing Open Hepatico-jejunostomy for Choledochal Malformations: a 43-year Single-center Experience

Stern,

Boroni,

Parolini

et al. 2023

Preprint

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“…A small-scale prospective trial from Tokyo involving 20 infants showed no difference in outcome [ 29 ] and interest seemed to wane. However, more recently this technique has become popular, at least in China where a recent questionnaire-based survey showed it was being used in half of their centres [ 30 ]. It is unclear whether this is in any way evidence-based.…”

Section: Discussionmentioning

confidence: 99%

Surgical and Medical Aspects of the Initial Treatment of Biliary Atresia: Position Paper

Davenport

Madadi-Sanjani

Chardot

et al. 2022

JCM

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Biliary atresia, a fibro-obliterative disease of the newborn, is usually initially treated by Kasai portoenterostomy, although there are many variations in technique and different options for post-operative adjuvant medical therapy. A questionnaire on such topics (e.g., open vs. laparoscopic; the need for liver mobilisation; use of post-operative steroids; use of post-operative anti-viral therapy, etc.) was circulated to delegates (n = 43) of an international webinar (Biliary Atresia and Related Diseases—BARD) held in June 2021. Respondents were mostly European, but included some from North America, and represented 18 different countries overall. The results of this survey are presented here, together with a commentary and review from an expert panel convened for the meeting on current trends in practice.

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Primary exploring the value of metagenomic next‐generation sequencing in detecting pathogenic bacteria of cholangitis with biliary atresia after Kasai operation

Li²,

Sun³

et al. 2022

Pediatr Surg Int

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To evaluate the value of metagenomic next-generation sequencing (mNGS) in detecting pathogenic bacteria of cholangitis for patients with biliary atresia after Kasai operation. MethodsPatients of biliary atresia with cholangitis after Kasai operation who were admitted to Xi'an Children's Hospital from July 2019 to December 2021 were retrospectively analyzed. Both blood culture and mNGS were carried out in all of these patients. The detection rate of pathogenic bacteria, pathogenic bacteria spectrum, test time, in ammatory indicators and liver function were compared. The correlation between drug resistance gene and drug resistance phenotype was analyzed. All the patients were followed up for 0.5-3 years to evaluate the onset of cholangitis and the survival status of autologous liver. Resultsa total of 30 episodes of cholangitis in 25 patients were included in this study. There were signi cant differences in the detection rate of pathogenic bacteria [23.3 vs.73.3%, P < 0.05] and the test time [120 (114.5-120) vs.16 (16-21) h, P < 0.001] between the blood culture and mNGS. In ammatory indicators (CRP, PCT) and liver function (TB, DB, GGT) were compared before and after anti-infection, and there was signi cant statistical difference with two methods. Four kinds of bacteria were detected by blood cultures, and 10 kinds of bacteria were detected by mNGS. The drug-resistant phenotypes and drugresistant genotypes of 3 Klebsiella pneumoniae strains were compared, h Cholangitis occurred 3 times in 1 case (4%) and twice in 3 cases (12%). Autologous liver survived in 17 cases (68%). ConclusionCompared with traditional blood culture, mNGS is more e cient, convenient and accurate in the detection of pathogens. It provides a new method for the accurate detection of pathogenic bacteria of cholangitis with biliary atresia after Kasai operation.

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Investigation into multi-centre diagnosis and treatment strategies of biliary atresia in mainland China

Cited by 8 publications

References 23 publications

Long-term Outcome for Children Undergoing Open Hepatico-jejunostomy for Choledochal Malformations: a 43-year Single-center Experience

Long-term Outcome for Children Undergoing Open Hepatico-jejunostomy for Choledochal Malformations: a 43-year Single-center Experience

Surgical and Medical Aspects of the Initial Treatment of Biliary Atresia: Position Paper

Primary exploring the value of metagenomic next‐generation sequencing in detecting pathogenic bacteria of cholangitis with biliary atresia after Kasai operation

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