Ultrasound Guided Percutaneous Cholecystocholangiography for Early Differentiation of Cholestatic Liver Disease in Infants

Treem, William R.; Grant, Edward E.; Barth, Klemens H.; Kremers, Peter W.

doi:10.1097/00005176-198805000-00006

Cited by 10 publications

(6 citation statements)

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“…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%

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: Introductionmentioning

confidence: 99%

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

2007

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“…Alternative diagnostic procedures include neonatal endoscopic retrograde cholangiopancreatography (ERCP), diagnostic laparoscopy, 2 spiral CT cholangiography, 3 magnetic resonance cholangiography, 4 and ultrasound-guided percutaneous cholecystocholangiography (PCC). 5 After experimenting with many of these alternatives, we have come to strongly prefer PCC.…”

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confidence: 99%

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

Meyers

Book

O’Gorman

et al. 2004

Journal of Pediatric Surgery

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“…In fact the inability to percutaneously cannulate the biliary tree is highly suggestive of BA, and our interventional radiologists (JA) recommend proceeding to diagnostic laparotomy after an inconclusive PC. Since it was reported in BA patients in 1988, PC has become a valuable preoperative test in this setting, and its safety and ease-of-use have improved [6,22]. Though invasive, improved technique by interventional radiologists has made this modality possible even in patients with a small GB, and PC may exclude BA in up to 47% of infants studied [23].…”

Section: Discussionmentioning

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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Ultrasound Guided Percutaneous Cholecystocholangiography for Early Differentiation of Cholestatic Liver Disease in Infants

Cited by 10 publications

References 0 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

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

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

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