Duodenal intubation and test for bile - a reliable method to rule out biliary atresia

Abstract

Between January 1997 and December 1998, 30 consecutive children with suspected biliary atresia (BA) were selected to assess whether duodenal intubation (DI) and testing of aspirate for bile would help to rule out BA. Duodenal fluid was aspirated every 2 h for 24 h and tested for bile. A HIDA scan was also done in all cases. Every patient underwent a peroperative cholangiogram (POC) and liver biopsy; a Kasai portoenterostomy was done in indicated cases. In 22 cases all three investigations (DI, HIDA scan, POC) suggested BA. In 3 the HIDA scan ruled out BA, but DI and POC suggested BA. In 2 other cases, both the HIDA scan and DI suggested BA, but POC ruled it out and suggested biliary hypoplasia; in 3 others the HIDA scan suggested BA, but DI and POC both, ruled it out. There was no case where DI ruled out BA (i.e., showed bile in aspirate) and POC suggested BA. A liver biopsy confirmed BA in all proven cases. DI and testing the aspirate for bile is a very reliable means to rule out BA if the aspirate tests positive. It is an inexpensive, noninvasive, and quick bedside test that may be especially useful in developing countries where biliary scintigraphy is not available.

Total Bile Acid Concentration in Duodenal Fluid Is a Useful Preoperative Screening Marker to Rule Out Biliary Atresia

“…If the color of duodenal fluid was bile-pigmented yellow, the patency of the extrahepatic bile duct was proved, and BA was denied. DTT was first reported in 1979 (5) and several studies explore the efficacy of DTT (6)(7)(8)(9)(10). In previous studies, the outcome of DTT was accessed by the color of duodenal fluid, and they showed high sensitivity (90.6%-100%) and relatively low specificity (60%-93.7%).…”

“…In DTT, a nasoduodenal tube is passed into the third portion of the duodenum, and duodenal fluid is collected to examine the presence of bile (3). Although several studies have evaluated the accuracy of DTT in the diagnosis of BA, the sensitivity and specificity of bile‐negative or bile‐positive DTT have been assessed by the color of duodenal fluid (5–10), and quantitative and objective values were not present. In this study, we assessed bile‐negative or bile‐positive DTT using duodenal total bile acid (TBA) concentrations in combination with serum markers and examined its efficacy as a screening method to rule out BA.…”

Pathogenesis and Outcome of Biliary Atresia: Current Concepts

“…The use of endoscopic retrograde cholangiopancreatography (ERCP) has been proposed for identification of the extrahepatic biliary tree, although it requires considerable technical expertise and general anesthesia, and the proper sized side‐viewing endoscope is not widely available (100,101). Finally, several groups have reported the usefulness of analyzing a duodenal bile specimen for presence of bilirubin or bile acids (102,103) as a test to demonstrate patency of the extrahepatic biliary tree.…”

“…able technical expertise and general anesthesia, and the proper sized side-viewing endoscope is not widely available (100,101). Finally, several groups have reported the usefulness of analyzing a duodenal bile specimen for presence of bilirubin or bile acids (102,103) as a test to demonstrate patency of the extrahepatic biliary tree.…”