Endoscopic retrograde cholangiopancreaticography prior to explorative laparotomy avoids unnecessary surgery in patients suspected for biliary atresia

Petersen, Claus; Meier, P. N.; Schneider, Andrea; Turowski, Carmen; Pfister, Eva Doreen; Manns, Michael P.; Ure, Benno M.; Wedemeyer, Jochen

doi:10.1016/j.jhep.2009.06.025

Cited by 55 publications

(42 citation statements)

References 26 publications

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“…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]. In some selected centers, endoscopic retrograde cholangiopancreatography (ERCP) is done as an alternative to PC and there are data supporting its feasibility and accuracy in the pediatric population [24,25]. ERCP may be an acceptable alternative to PC in the workup of BA but this was not assessed in the current study, since ERCP is rarely performed at our institution.…”

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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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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“…our practice is to use endoscopic retrograde cholangiography selectively mainly when findings in radioisotope excretion scan and liver biopsy are uncertain (17). Intraoperative cholangiography is performed before portoenterostomy if there is any doubt of the diagnosis at the time of operation.…”

Section: Diagnosismentioning

confidence: 99%

Surgery of Biliary Atresia

Pakarinen

Rintala

2011

Scand J Surg

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biliary atresia (ba) is a progressive fibro-obliterative cholangiopathy of unclear etiology affecting varying degrees of both extra-and intrahepatic biliary tree resulting in obstructive bile flow and cholestasis in neonates. the diagnostic work-up is designed to diagnose or rule out ba without any unnecessary delay. Kasai portoenterostomy is a palliative operation performed to establish bile drainage from microscopic bile ductules that remain in the porta hepatis. it is advantageous to perform portoenterostomy as early after birth as possible for better chances of success. actuarial native liver 5-year survival rates range from 30% to 60% after portoenterostomy, and about 20% of all patients undergoing Kasai portoenterostomy during infancy survive into adulthood with their native liver. Portoenterostomy remains as the first line operative treatment in ba while liver transplantation serves as a salvage treatment when portoenterostomy fails or liver function gradually deteriorates after initially successful establishment of bile flow.

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“…The rapid diagnosis of BA is paticularly important because early surgical intervention by hepatoportoenterostomy before 2 months of age correlates with better long-term outcome (4–8). Unfortunately, the diagnosis of NC is often delayed and the average age at diagnosis of BA is about 60 days in USA and Germany (9, 10). For these reasons, the fractionated bilirubin must be determined in any infant presenting with prolonged jaundice lasting longer for 14 days of age for term and 21 days for preterm infants with or without depigmented stool.…”

Section: Introductionmentioning

confidence: 99%

“…Histology is characterized by inflammatory cell infiltrates around bile ducts, portal tract fibrosis, accumulation of bile typically presenting as bile plugs, and bile duct proliferation. ERCP may serve as a reliable and safe additional diagnostic tool (10, 26, 27) exhibiting a sensitivity of up to 86–92% and a specificity of 73–94% (10, 28). Hepatobiliary sequence scintigraphy is associated with a high sensitivity (83–100%) but lacks specificity in many cases (33–80%), limiting its usefulness to discriminate between BA and other non-surgical conditions (29).…”

Section: Introductionmentioning

confidence: 99%

Neonatal Cholestasis â€“ Differential Diagnoses, Current Diagnostic Procedures, and Treatment

et al. 2015

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Cholestatic jaundice in early infancy is a complex diagnostic problem. Misdiagnosis of cholestasis as physiologic jaundice delays the identification of severe liver diseases. In the majority of infants, prolonged physiologic jaundice represent benign cases of breast milk jaundice, but few among them are masked and caused by neonatal cholestasis (NC) that requires a prompt diagnosis and treatment. Therefore, a prolonged neonatal jaundice, longer than 2 weeks after birth, must always be investigated because an early diagnosis is essential for appropriate management. To rapidly identify the cases with cholestatic jaundice, the conjugated bilirubin needs to be determined in any infant presenting with prolonged jaundice at 14 days of age with or without depigmented stool. Once NC is confirmed, a systematic approach is the key to reliably achieve the diagnosis in order to promptly initiate the specific, and in many cases, life-saving therapy. This strategy is most important to promptly identify and treat infants with biliary atresia, the most common cause of NC, as this requires a hepatoportoenterostomy as soon as possible. Here, we provide a detailed work-up approach including initial treatment recommendations and a clinically oriented overview of possible differential diagnoses in order to facilitate the early recognition and a timely diagnosis of cholestasis. This approach warrants a broad spectrum of diagnostic procedures and investigations including new methods that are described in this review.

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Endoscopic retrograde cholangiopancreaticography prior to explorative laparotomy avoids unnecessary surgery in patients suspected for biliary atresia

Cited by 55 publications

References 26 publications

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

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

Surgery of Biliary Atresia

Neonatal Cholestasis â€“ Differential Diagnoses, Current Diagnostic Procedures, and Treatment

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