Predictive value of hepatic ultrasound, liver biopsy, and duodenal tube test in the diagnosis of extrahepatic biliary atresia in Serbian infants

Abstract

Background/Aims: Extrahepatic biliary atresia (EHBA) is the most important cause of neonatal cholestasis. The validity of different diagnostic methods in the diagnosis of EHBA in developed countries has been presented elsewhere, but data from developing countries with low national incomes are scarce. The aim of this study was to investigate the relative accuracy and roles of abdominal ultrasonography, duodenal tube test (DTT), and liver biopsy in the diagnosis of EHBA in Serbia. Materials and Methods: The study included 156 infants with cholestasis admitted at the Mother and Child Health Care Institute. Data were collected according to the medical records observation technique. Results: Extrahepatic biliary atresia was diagnosed in 72 of 156 infants with cholestasis. The frequency was insignificantly higher in females than in males (1.25:1). Most patients were diagnosed prior to 60 days of life (median 58, range 30-67). In a group of 156 infants with cholestasis, 109 had ultrasound, liver biopsy, duodenal tube test, and intraoperative cholangiography done. Liver biopsy confirmed surgical disease in 71/109 patients and denied it in 38/109 patients (sensitivity-Sn 98%, specificity-Sp 100%, diagnostic efficiency of test-DgEf 99.08%). Duodenal tube test had Sn 97%, Sp 72%, and DgEf 88.99%, and the ultrasound findings showed Sn 78%, Sp 81%, and DgEf 77.92%. Five-year survival rate after Kasai operation was 76%. Conclusion: A well-coordinated multidisciplinary approach is required in the assessment of suspected cases of biliary atresia. Histology examination of biopsy specimens is an integral part of the diagnostic algorithm and, therefore, plays a pivotal role in the diagnostic evaluation of this disease.

Evaluation of Infants with Neonatal Cholestasis: Experience of a Tertiary Referral Center in Turkey

“…9,10,15,17 Liver biopsy remains the gold standard for differentiating causes of neonatal cholestasis with high sensitivity and specificity. 9,14,18 In the present study, concordant with the literature, 21 (28%) of the 75 patients had BA, 54 (72%) had NH with 29 (39%) of them were idiopathic. Previous studies showed that infants with NH had variable prognosis, but in 60% to 70% of cases liver functions might return to normal ranges with optimal nutritional support.…”

Development and Validation of Novel Diagnostic Models for Biliary Atresia in a Large Cohort of Chinese Patients

“…Therefore, it is critical to establish reliable models for the early detection and diagnosis of BA. Unfortunately, the definitive diagnosis and confirmation of BA in suspected infants generally requires a liver biopsy and intraoperative cholangiography (IOC) during the surgical procedure, and these diagnostic methods have turned out to be invasive, time-consuming, and costly [ 6 , [17] , [18] , [19] , [20] ]. Obviously, there is an urgent need for a reliable and better diagnostic approach to distinguish BA from other form of neonatal cholestasis (NC) with different causes.…”

The Role of Endoscopic Retrograde Cholangiopancreatography in the Diagnosis of Biliary Atresia: 14 Years' Experience

“…This is similar to results of others who found a sensitivity of 97% and NPV of 93 or 98.6% if bile fluid was present. 16,17 In our study, infants diagnosed with BA had GGT levels that were about twice as high as in patients with other cholestatic liver diseases. This is in accordance with other studies 18,19 who also found higher GGT concentrations.…”

“…Scoring systems to assess the risk of BA have been developed, but they involve taking liver biopsies. 16,[33][34][35] We have developed a scoring system without risky interventions. It may be helpful in centers that do not have the expertise with this rare disease and that do not have the specialists to perform ERCPs in infants.…”