Percutaneous Endoscopic Gastrostomy tube has now replaced surgical gastrostomy because of low rate of complications. PEG tube feeding is recommended in children for many conditions including neurological disabilities with feeding difficulty. The procedure of placing a PEG tube is simple, safe and well tolerated even by small infants and children, if done by experienced pediatric gastroenterologist.

BACKGROUND: Aim of this prospective study was to evaluate prospectively the role of triangular cord sign in diagnosing biliary atresia and also to assess the prognostic value of trianular cord (TC) sign. METHODS: We prospectively studied 65 consecutive infants with conjugated bilirubinemia who underwent ultrasonography examination to look for TC sign. US examination was performed by a single operator who was blinded to results of other investigations, with a 7.5 MHz multi-frequency microconvex transducer and a 12 MHz multi-frequency linear assay transducer. The final diagnosis of biliary atresia was made on the basis of surgery. The role of TC sign in diagnosis biliary atresia was evaluated. RESULTS: 25 infants (15male &10female) had surgically confirmed biliary atresia and 40 (26 male & 14 female) had other documented causes of cholestasis. TC sign had a sensitivity, specificity, Positive Predictive value and Negative Predictive value of 80%, 97.5%, 95.23% and 88.63% respectively. Fibrosis Score of >3 in liver histopathology was found in 18 out of 20 TC sign positive cases. CONCLUSION: TC sign is a noninvasive, specific, time saving, simple diagnostic tool in the evaluation of infants with cholestasis. TC sign has a diagnostic as well as prognostic value in biliary atresia.