Percutaneous cholecysto-cholangiography in the diagnosis of obstructive jaundice in infants

Meyers, Rebecka L.; Book, Linda S.; O’Gorman, Molly; White, Keith W; Jaffe, Richard; Feola, Peter; Hedlund, Gary L.

doi:10.1016/j.jpedsurg.2003.09.008

Cited by 32 publications

(20 citation statements)

References 7 publications

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“…In a recent report, Meyers et al [7] successfully avoided OCG in five of nine infants undergoing PCC. In order to improve the diagnostic yield of this procedure, we have applied a strict selection criteria that includes clear US identification of a gallbladder with a patent lumen.…”

Section: Discussionmentioning

confidence: 99%

“…Since the first report of this procedure appeared 20 years ago, only a few other accounts of its use have been published [5][6][7]. PCC is performed under sedation, provides assessment of intrahepatic and extrahepatic biliary anatomy, and permits concomitant liver biopsy for the definitive diagnosis of neonatal hepatitis or other hepatic disorders.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Definitive exclusion of biliary atresia in infants with cholestatic jaundice: the role of percutaneous cholecysto-cholangiography

2007

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Definitive exclusion of biliary atresia in the infant with cholestatic jaundice usually requires operative cholangiography. This approach suffers from the disadvantage that sick infants are subjected to a time-consuming and potentially negative surgical exploration. The purpose of this study was to determine if percutaneous cholecystocholangiography (PCC) prevents unnecessary laparotomy in infants whose cholestasis is caused by diseases other than biliary atresia. This study is a 10 year retrospective review of all infants with persistent direct hyperbilirubinemia and inconclusive biliary nuclear scans who underwent further evaluation for suspected biliary atresia. A gallbladder ultrasound (US) was obtained in all patients. When the gallbladder was visualized, further imaging by PCC was done under intravenous sedation; otherwise, the standard operative cholangiogram (OCG) was performed, with liver biopsy as indicated. The primary outcome was the diagnostic accuracy of PCC, especially with respect to preventing a laparotomy. There were 35 infants with suspected biliary atresia, with a mean age of 8 weeks (range 1-14 weeks). Nine infants whose gallbladder was visualized by ultrasound underwent PCC that definitively excluded biliary atresia. Of this group, the most frequent diagnosis (five patients) was total parenteral nutrition-associated cholestasis. The other 26 infants with absent or decompressed gallbladder had laparotomy and OCG, which identified biliary atresia in 16 patients (61%). Laparotomy was avoided in all 9 patients who underwent PCC, thus reducing the negative laparotomy rate by 47%. There were no complications associated with PCC. Several alternative techniques to operative cholangiogram have been described for the definitive exclusion of biliary atresia, but many of these have distinct drawbacks. Advances in interventional radiology techniques have permitted safe percutaneous contrast evaluation of the biliary tree. Identification of a normal gall bladder on sonogram is highly predictive of the absence of biliary atresia. Further confirmation can be accurately obtained by a combination of PCC and percutaneous liver biopsy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Definitive exclusion of biliary atresia in infants with cholestatic jaundice: the role of percutaneous cholecysto-cholangiography

2007

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“…Studies were performed using gallbladder cannulation with a standard technique [6]. Intraoperative cholangiogram findings were also reviewed but only used for endpoint determination.…”

Section: Data Acquisitionmentioning

confidence: 99%

A screening algorithm for the efficient exclusion of biliary atresia in infants with cholestatic jaundice

Jancelewicz

Barmherzig

Chung

et al. 2015

Journal of Pediatric Surgery

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“…En cas de doute diagnostique persistant, la perméabilité de l'arbre biliaire doit être vérifiée par cholangiographie : percutanée radiologique [32], endoscopique rétrograde [33,34] ou chirurgicale (laparoscopique ou par miniparatotomie), le choix des techniques dépendant des préférences des équipes, tout en évitant les pertes de temps et la répétition des anesthé-sies générales [35]. La résolution du cholangio-IRM ne permet pas actuellement d'exclure de façon fiable une AVB [36].…”

Section: Diagnostic De Cholestaseunclassified

Les cholestases néonatales

Debray

Chardot

2010

Rev. med. perinat.

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Percutaneous cholecysto-cholangiography in the diagnosis of obstructive jaundice in infants

Cited by 32 publications

References 7 publications

Definitive exclusion of biliary atresia in infants with cholestatic jaundice: the role of percutaneous cholecysto-cholangiography

Definitive exclusion of biliary atresia in infants with cholestatic jaundice: the role of percutaneous cholecysto-cholangiography

A screening algorithm for the efficient exclusion of biliary atresia in infants with cholestatic jaundice

Les cholestases néonatales

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