Current concept about postoperative cholangitis in biliary atresia

Abstract

Cholangitis is one of the most important determinants of long-term survival after the Kasai's procedure. The knowledge on postoperative cholangitis has been increasing in the past 10 years, showing a lower incidence of the disease and better therapeutic results.

BILIARY ATRESIA: evaluation on two distinct periods at a reference pediatric service

“…Hepatobiliary scintigraphy has a limited value because it presents with high sensitivity, often at 100%, and has disagreeing values about its specificity, varying from 40% to 100% (2) . Although duodenal tubing has been reported as a useful method for BA diagnosis, with a specificity of 93.7% and a sensitivity varying from 97.3% to 100% (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) , it was responsible for the delay in propaedeutics at this institution (37) . It is mandatory to improve the agility in diagnosis, increase the efficiency of the diagnosis process, and decrease the time gap between referral and portoenterostomy.…”

“…It is a disease of both the intra-and extrahepatic bile ducts resulting from an inflammatory process which leads to the absence or progressive obliteration of ducts (26,37) . Etiopathogenic factors are unknown, however, multifactorial events may play a role (4) , in which genetic and environmental factors interact to promote the obliteration of the biliary tree (16,32) .…”

Single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography for treatment of cholangitis in a patient with a Kasai portoenterostomy

“…The mechanism for this complication is not entirely clear, but likely contributors include intestinal bacterial stasis and incomplete biliary drainage [11]. Afferent limb intestinal obstruction at the mesocolic window has also been reported to cause cholangitis [12].…”

Management of Biliary Atresia: A Review

“…The incidence of cholangitis in these patients is between 40 and 90 percent, with the majority of patients experiencing at least one episode prior to two years of age. Because cholangitis can be life threatening and may impact long-and short-term outcomes 68 , most clinicians prescribe prophylactic antibiotics in the first year of life. Small non-randomized trials suggest that the benefits of antibiotic prophylaxis outweigh the risks of antibiotic resistance.…”