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Franceschi P, Brandi N, Pecorelli A, Vitale G, Cescon M, Renzulli M. Reverse Mirizzi Syndrome. Radiol Case Rep 2023; 18:4157-4159. [PMID: 37745768 PMCID: PMC10511724 DOI: 10.1016/j.radcr.2023.08.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
A man in his 40s presented to our Hospital with abdominal pain, jaundice, and pruritus. He had a history of Alagille Syndrome treated with cholecystojejunostomy in the neonatal period because of initial misdiagnosis of biliary atresia. Laboratory investigations showed hyperbilirubinemia (total bilirubin 1.76 mg/dL [<1.2 mg/dL]; conjugated 1.06 mg/dL [<0.3 mg/dL]) and cholestasis (GGT 78 U/L [<50 U/L]; ALP 200 U/L [<50 U/L]). Transabdominal ultrasound was limited by aerobilia due to the cholecystojejuno-anastomosis. Subsequent basal CT scan revealed an impacted stone within the patient's native common bile duct (CBD). Aerobilia in intrahepatic bile ducts and gallbladder was reported. Magnetic Resonance cholangiopancreatography confirmed the gallstone in the CBD compressing cystic duct and common hepatic duct, with dilation of the upstream bile ducts. Furthermore, the native CBD was obstructed by other gallstones. In Mirizzi syndrome, gallstones impacted in gallbladder's Hartmann's pouch or cystic duct extrinsically compress CBD. We suggest naming the present condition "Reverse Mirizzi Syndrome" (Renzulli Matteo Syndrome, RMS) because it is the exact opposite of Mirizzi syndrome.
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Affiliation(s)
- Paola Franceschi
- Department of Radiology, IRCSS Azienda Ospedaliero Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Nicolò Brandi
- Department of Radiology, IRCSS Azienda Ospedaliero Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Anna Pecorelli
- Department of Radiology, IRCSS Azienda Ospedaliero Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Giovanni Vitale
- Unit of Internal Medicine for the Treatment of Severe Organ Failure, Surgical Department of Digestive, Hepatic and Endocrine-Metabolic Diseases, IRCSS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Matteo Cescon
- Hepatobiliary Surgery and Organ Transplantation, IRCSS Azienda Ospedaliero Universitaria di Bologna, Via G. Massarenti 9, Bologna, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCSS Azienda Ospedaliero Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
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Weng Z, Ye F, Zhou L, Chen F, Ling W, Fang Y, Liu M, Wu Q, Qiu X, Lyu G. A nomogram model based on preoperative grey-scale US features and routine serum biomarkers to predict the outcome of infants with biliary atresia after Kasai portoenterostomy. Front Pediatr 2022; 10:972855. [PMID: 36340714 PMCID: PMC9631934 DOI: 10.3389/fped.2022.972855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To establish a nomogram to predict the outcome of biliary atresia (BA) infants 3-months post- Kasai portoenterostomy (KPE). METHODS BA Infants who underwent KPE from two hospitals were included in the training (n = 161) and validation cohorts (n = 64). A logistic regression equation (Equation A) for predicting the serum total bilirubin (TBIL) level 3-month post-KPE was established in the training cohort. Then, a nomogram was developed based on Equation A in the training cohort and validated in the validation cohort. Moreover, a new equation (Equation B) was generated based on the nomogram and the size of the enlarged hilar lymph nodes (LNs) in the validation cohort. The predictive performance of the nomogram was evaluated by the receiver operating characteristic (ROC) curve and by calculating the area under the ROC curve (AUC), sensitivity, specificity, and positive (PPV) and negative (NPV) prediction values. RESULTS A nomogram based on gallbladder morphology and serum levels of TBIL and total protein (TP) was established with AUC (95%CI) of 0.673 (0.595, 0.745) and 0.647 (0.518, 0.763), sensitivity (95%CI) of 71.4% (62.1%,79.6%) and 81.8% (59.7%,94.8%), specificity (95%CI) of 63.3% (48.3%,76.6%) and 47.6% (32.0%,63.6%), PPV (95%CI) of 81.6% (72.5%,88.9%) and 45.0% (29.3%,61.5%), and NPV (95%CI) 49.2% (36.4%,62.1%) and 83.3% (62.6%,95.3%), respectively, in the training and validation cohorts. Furthermore, in the validation cohort, the AUC (95%CI) of Equation B was 0.798 (95%CI: 0.679, 0.888), which was significantly higher than that of the nomogram (P = 0.042). CONCLUSION A nomogram based on the pre-KPE gallbladder morphology, TBIL, and TP to predict the outcome of BA 3-months post-KPE is established. Moreover, the addition of the size of the enlarged hilar LNs into the nomogram further improves its predictive value.
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Affiliation(s)
- Zongjie Weng
- Department of Medical Ultrasonics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics / Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Fengying Ye
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics / Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Luyao Zhou
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Fa Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Wen Ling
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics / Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Yifan Fang
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics / Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Min Liu
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics / Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qiumei Wu
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics / Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiuqing Qiu
- Department of Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics / Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Guorong Lyu
- Department of Medical Ultrasonics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, China
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Liver Transplantation for Biliary Atresia in Adulthood: Single-Centre Surgical Experience. J Clin Med 2021; 10:jcm10214969. [PMID: 34768489 PMCID: PMC8584637 DOI: 10.3390/jcm10214969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Biliary atresia (BA) is the most common indicator for liver transplant (LT) in children, however, approximately 22% will reach adulthood with their native liver, and of these, half will require transplantation later in life. The aim of this study was to analyse the surgical challenges and outcomes of patients with BA undergoing LT in adulthood. Methods: Patients with BA requiring LT at the age of 16 or older in our unit between 1989 and 2020 were included. Pretransplant, perioperative variables and outcomes were analysed. Pretransplant imaging was reviewed to assess liver appearance, spontaneous visceral portosystemic shunting (SPSS), splenomegaly, splenic artery (SA) size, and aneurysms. Results: Thirty-four patients who underwent LT for BA fulfilled the inclusion criteria, at a median age of 24 years. The main indicators for LT were synthetic failure and recurrent cholangitis. In total, 57.6% had significant enlargement of the SA, 21% had multiple SA aneurysm, and SPSS was present in 72.7% of the patients. Graft and patient survival at 1, 5, and 10 years was 97.1%, 91.2%, 91.2% and 100%, 94%, 94%, respectively Conclusions: Good outcomes after LT for BA in young patients can be achieved with careful donor selection and surgery to minimise the risk of complications. Identification of anatomical variants and shunting are helpful in guiding attitude at the time of transplant.
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Hilscher MB, Kamath PS, Eaton JE. Cholestatic Liver Diseases: A Primer for Generalists and Subspecialists. Mayo Clin Proc 2020; 95:2263-2279. [PMID: 33012354 DOI: 10.1016/j.mayocp.2020.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 01/03/2020] [Accepted: 01/16/2020] [Indexed: 02/08/2023]
Abstract
Cholestasis describes impairment in bile formation or flow which can manifest clinically with fatigue, pruritus, and jaundice. The differential diagnosis of cholestatic liver diseases is broad, and the etiologies of cholestasis vary in the anatomical location of the defect and acuity of presentation. Cholestasis may occur in a variety of clinical scenarios. Therefore, it is important for a diverse audience with varied clinical practices to have a basic understanding of manifestations of cholestatic liver diseases.
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Affiliation(s)
- Moira B Hilscher
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - John E Eaton
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
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D'Souza R, Grammatikopoulos T, Pradhan A, Sutton H, Douiri A, Davenport M, Verma A, Dhawan A. Acute-on-chronic liver failure in children with biliary atresia awaiting liver transplantation. Pediatr Transplant 2019; 23:e13339. [PMID: 30597734 DOI: 10.1111/petr.13339] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/05/2018] [Accepted: 11/25/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Acute-on-chronic liver failure (ACLF) is an acute decompensation of cirrhosis complicated by other organ failure and is associated with increased mortality and morbidity. ACLF has not been studied in children with biliary atresia (BA), which is the commonest indication for pediatric liver transplantation (LT) worldwide. This study aims to evaluate ACLF and outcomes in children with BA while awaiting deceased donor LT. METHODS This was a subanalysis of the dataset from a prospective cohort study of patients aged 0-18 years who underwent portoenterostomy for BA and were listed for LT at King's College Hospital, London, between 1999 and 2003. Outcomes included the development of ACLF, mortality, and complications. RESULTS Ninety-nine (41 male) children were included, and follow-up was 10 [6.0-15.0] years. A total of 20/99 children developed ACLF. ACLF was associated with increased mortality while awaiting LT (20% vs 4%; P = 0.03). There were no associations between biochemical parameters at listing and death. Increased bilirubin levels 3 months post-portoenterostomy was predictive of development of ACLF (AUROC = 0.72, P < 0.01). Age at LT and time on the waiting list in the ACLF subgroup were both lower compared to the non-ACLF group (P > 0.05). Sepsis and gastrointestinal bleeding were the commonest precipitants of ACLF. Complications included ascites, hepatic encephalopathy, and hepatorenal syndrome; the ACLF subgroup required multisystem support and longer intensive care unit stay. CONCLUSIONS ACLF in children with BA awaiting deceased donor LT carries increased mortality and morbidity. This warrants stratification of patients for earlier wait-listing and prioritization for LT.
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Affiliation(s)
- Rashmi D'Souza
- Paediatric Liver, Gastroenterology and Nutrition Centre, King's College Hospital, London, UK
| | - Tassos Grammatikopoulos
- Paediatric Liver, Gastroenterology and Nutrition Centre, King's College Hospital, London, UK
| | | | - Harry Sutton
- Paediatric Liver, Gastroenterology and Nutrition Centre, King's College Hospital, London, UK
| | - Abdel Douiri
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Mark Davenport
- Paediatric Liver, Gastroenterology and Nutrition Centre, King's College Hospital, London, UK
| | - Anita Verma
- Paediatric Liver, Gastroenterology and Nutrition Centre, King's College Hospital, London, UK.,Department of Medical Microbiology, King's College Hospital, London, UK
| | - Anil Dhawan
- Paediatric Liver, Gastroenterology and Nutrition Centre, King's College Hospital, London, UK
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Averbukh LD, Wu GY. Evidence for Viral Induction of Biliary Atresia: A Review. J Clin Transl Hepatol 2018; 6:410-419. [PMID: 30637219 PMCID: PMC6328731 DOI: 10.14218/jcth.2018.00046] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 12/14/2022] Open
Abstract
Biliary atresia (BA) is a childhood disease which manifests with abnormal narrowing, blockage or complete absence of bile ducts within the liver. Many possible etiologies have been reported for the development of BA, including congenital, perinatal and acquired conditions. Since the 1970's, there has been increasing evidence linking BA development to viral perinatal infections. The viral vectors most commonly implicated include members of the herpesviridae family (cytomegalovirus and Epstein-Barr virus) as well as those of the reoviridae family (reovirus and rotavirus). While extensive work has been done on a murine model of disease, the current review focuses primarily on evidence from human studies of viral vectors in children afflicted with BA.
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Affiliation(s)
- Leon D. Averbukh
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
- *Correspondence to: Leon D. Averbukh, Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, 236 Farmington Ave., Farmington, CT 06030, USA. Tel: +1-347-306-4752, E-mail:
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The Application of a Shorter Loop in Kasai Portoenterostomy Reconstruction for Ohi Type III Biliary Atresia: A Prospective Randomized Controlled Trial. J Surg Res 2018; 232:492-496. [DOI: 10.1016/j.jss.2018.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 06/08/2018] [Accepted: 07/02/2018] [Indexed: 11/20/2022]
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Ji Y, Yang K, Zhang X, Chen S, Xu Z. Learning curve of laparoscopic Kasai portoenterostomy for biliary atresia: report of 100 cases. BMC Surg 2018; 18:107. [PMID: 30477451 PMCID: PMC6260779 DOI: 10.1186/s12893-018-0443-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/08/2018] [Indexed: 02/05/2023] Open
Abstract
Background Laparoscopic Kasai portoenterostomy (LKPE) is performed for biliary atresia (BA). As LKPE is a technically demanding operation, a learning curve should be defined to guide training. The aim of this study was to identify the learning curve of LKPE for BA. Methods Metrics of perioperative safety and efficiency for 100 cases of LKPE were evaluated. Outcomes were followed to 67.2 ± 12.1 months. Cumulative sum (CUSUM) analysis was used to identify inflexion point corresponding to the learning curve. Outcome measures included operative time (ORT), rate of clearance of jaundice (CJ) and survival with native liver (SNL). Results Between May 2009 and May 2013, 100 consecutive patients with BA underwent LKPE. The rate of conversion from LKPE to open Kasai portoenterostomy (OKPE), intraoperative transfusion and any perioperative complications was 11, 26 and 16%, respectively. There was no perioperative mortality. The CUSUM analysis revealed a learning curve of 50 for LKPE. Precipitous ORT reductions from an initial mean operative time of 316.3 min that was observed in the first 50 to 232.2 min of the late 50 cases (P < 0.01). Subsequently, cases 1 to 50 were considered ‘early experience’, whereas cases 51 and higher were considered as ‘late experience’ for statistical analysis. The rate of CJ and SNL was significantly higher after the early 50 cases (P < 0.05). In contrast, the rate of intraoperative transfusion, the median time of oral feeding initiated after operation, and the length of hospital stay was not different between the both groups (P > 0.05). Conclusions In this experience, improved perioperative and postoperative parameters for LKPE were observed in the last 50 patients when compared with the first 50 patients. The dedicated training is likely to contribute to significantly shorter learning curves in future adopters.
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Affiliation(s)
- Yi Ji
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, #37 Guo-Xue-Xiang, Chengdu, 610041, China
| | - Kaiying Yang
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, #37 Guo-Xue-Xiang, Chengdu, 610041, China
| | - Xuepeng Zhang
- Pediatric Intensive Care Unit, Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Siyuan Chen
- Pediatric Intensive Care Unit, Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Zhicheng Xu
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, #37 Guo-Xue-Xiang, Chengdu, 610041, China.
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Kohaut J, Guérin F, Fouquet V, Gonzales E, de Lambert G, Martelli H, Jacquemin E, Branchereau S. First liver transplantation for biliary atresia in children: The hidden effects of non-centralization. Pediatr Transplant 2018; 22:e13232. [PMID: 29869366 DOI: 10.1111/petr.13232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2018] [Indexed: 11/30/2022]
Abstract
The aim of our study was to determine the impact of initial orientation for medical and surgical care of children with BA on procedures and outcomes of the first LT. We retrospectively analyzed charts of children with BA who underwent first LT between 2006 and 2015. Patients were divided into two groups for comparison: a single-center management group (from diagnosis to transplantation) and a secondarily referred group (children referred after failure of KP). We focused analysis on disease severity at transplantation, blood transfusion, and overall survival. One hundred and eighty-five children were included. The median delay between pretransplant check-up and transplantation was shorter in patients secondarily referred. A severe undernutrition was observed in 23.7% of children secondarily referred compared to 11.1% in children with a single-center management (P = .024). At transplantation, INR and factor V level were higher in single-center group patients (respectively, 67% vs 55%, P < .001 and 61% vs 49%, P = .002). The total of red blood cell and fresh frozen plasma administrated during procedure was two times higher in patients secondarily referred. Finally, patients with a single-center management had a higher overall 12 months of survival rate (92.1% vs 83.1%, P = .033). In a country without low-density population issues, the authors advocate an early referring to transplant center to further improving LT outcomes in children with BA.
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Affiliation(s)
- Jules Kohaut
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
- University Paris-Sud, Le Kremlin-Bicêtre, France
| | - Florent Guérin
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Virginie Fouquet
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Emmanuel Gonzales
- University Paris-Sud, Le Kremlin-Bicêtre, France
- Department of Pediatric Hepatology, Hôpitaux Universitaires Paris-Sud, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Guénolée de Lambert
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Hélène Martelli
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
- University Paris-Sud, Le Kremlin-Bicêtre, France
| | - Emmanuel Jacquemin
- University Paris-Sud, Le Kremlin-Bicêtre, France
- Department of Pediatric Hepatology, Hôpitaux Universitaires Paris-Sud, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Sophie Branchereau
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
- University Paris-Sud, Le Kremlin-Bicêtre, France
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Stagg H, Cameron BH, Ahmed N, Butler A, Jimenez-Rivera C, Yanchar NL, Martin SR, Emil S, Anthopoulos G, Schreiber RA, Laberge JM. Variability of diagnostic approach, surgical technique, and medical management for children with biliary atresia in Canada - Is it time for standardization? J Pediatr Surg 2017; 52:802-806. [PMID: 28189446 DOI: 10.1016/j.jpedsurg.2017.01.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/23/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Canadian 4-year native liver survival rate for biliary atresia (BA) after Kasai Portoenterostomy (KP) is 39%. The Canadian Biliary Atresia Registry (CBAR) was used to examine variability of surgical and medical management of BA. METHODS Gastroenterologists and surgeons in all 14 Canadian pediatric tertiary centers were invited to complete an online survey of their BA management practices. RESULTS Of gastroenterologists, diagnostic procedures included liver biopsy (92%), HIDA scan (58%), and percutaneous cholangiogram (46%). Surgeons reported Roux-en-Y lengths of 20-50cm with 78% avoiding diathermy at the portal plate; 16% performed laparoscopic exploration, but none laparoscopic KP. Postoperative corticosteroids and antibiotics were used by 24% and 85% of gastroenterologists, respectively, with similar rates for surgeons. At discharge, gastroenterologists prescribed oral antibiotics (80%), and ursodeoxycholic acid (95%), while surgeons reported lower rates (62% and 55%). Considerable variation existed in follow-up monitoring. No center had a standard protocol for evaluating suspected cholangitis. There was a lack of consensus for defining failed KP and referral criteria for transplant evaluation. CONCLUSION In Canada, treatment of BA is not centralized, and there is variability in diagnostic approaches and management. Collaboration through CBAR will allow for implementation and evaluation of standardized surgical and medical management with a goal to improve outcomes. LEVEL OF EVIDENCE Survey study. Level IV evidence.
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Affiliation(s)
- Hayden Stagg
- Department of Pediatric Surgery, Montreal Children's Hospital, Montreal, QC, Canada H4A 3J1
| | - Brian H Cameron
- Division of Pediatric Surgery, McMaster Children's Hospital, Hamilton, ON, Canada L8N3Z5
| | - Najma Ahmed
- Division of Pediatric Gastroenterology, Montreal Children's Hospital, Montreal, QC, Canada H4A 3J1
| | - Alison Butler
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada V6H 3V4
| | - Carolina Jimenez-Rivera
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada K1H 8L1
| | - Natalie L Yanchar
- Division of Pediatric Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada B3K 6R8
| | - Steve R Martin
- Division of Pediatric Gastroenterology, Alberta Children's Hospital, Calgary, AB, Canada T3B 6A8
| | - Sherif Emil
- Department of Pediatric Surgery, Montreal Children's Hospital, Montreal, QC, Canada H4A 3J1
| | | | - Richard A Schreiber
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada V6H 3V4
| | - Jean-Martin Laberge
- Department of Pediatric Surgery, Montreal Children's Hospital, Montreal, QC, Canada H4A 3J1.
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Rafeey M, Saboktakin L, Hasani JS, Naghashi S. Diagnostic value of anti-smooth muscle antibodies and liver enzymes in differentiation of extrahepatic biliary atresia and idiopathic neonatal hepatitis. Afr J Paediatr Surg 2016; 13:63-8. [PMID: 27251654 PMCID: PMC4955439 DOI: 10.4103/0189-6725.182558] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND We aimed to evaluate the diagnostic value of anti-smooth muscle antibodies (ASMA) and two liver markers (gamma-glutamyl transpeptidase [GGT] and alkaline phosphatase [ALP]) for differentiating between patients with extrahepatic biliary atresia (EHBA) and idiopathic neonatal hepatitis (INH). MATERIALS AND METHODS During April 2010-2011, all infants at 2 weeks of age who were diagnosed with cholestasis and admitted to Children's Hospital of Tabriz were enrolled. Based on the results of physical examination, laboratory, imaging and pathological studies, neonates were divided into two groups (EHBA and INH). Receiver operating characteristics analysis was used to define sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for ASMA, GGT and ALP. RESULTS Thirty neonates with cholestasis (18 with EHBA and 12 with INH) and mean age of 54.66 25.86 days were enrolled. Total and direct bilirubin, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase and ASMA titres were highly not significant (P > 0.05) in patients with INH. GGT (P = 0.008) and ALP (P = 0.01) had statistically significant differences that were higher in patients with EHBA. The sensitivity, specificity, PPV and NPV, accuracy, LR+ and LR- of SMA in differentiating cases with BA were 66.7%, 75%, 80% 60%, 70%, 2.68 and 0.44, respectively. For GGT, the values were 88.9%, 66.7%, 80%, 80%, 79.1%, 3.08 and 0.31, respectively. Finally, for ALP, the values were 77.8%, 75%, 82.4%, 69.2%, 80%, 2.66 and 0.24, respectively. CONCLUSION Our study showed that ASMA may be a useful biomarker for differentiation of EHBA from INH. Further studies with larger samples are recommended for confirming the results of this study.
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Affiliation(s)
- Mandana Rafeey
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Lida Saboktakin
- Department of Pediatrics, Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jamshid Shoa Hasani
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahnaz Naghashi
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Wang P, Xun P, He K, Cai W. Comparison of liver transplantation outcomes in biliary atresia patients with and without prior portoenterostomy: A meta-analysis. Dig Liver Dis 2016; 48:347-52. [PMID: 26748427 DOI: 10.1016/j.dld.2015.11.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 11/15/2015] [Accepted: 11/19/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Portoenterostomy is currently the standard first procedure for biliary atresia, and liver transplantation is reserved as a complementary therapy for those with late diagnosis, rapid hepatic decompensation, or failed portoenterostomy. Many previous publications have analysed the impact of prior portoenterostomy on the clinical outcomes of liver transplantation and the conclusions are discordant. METHODS PubMed and EMBASE were systematically searched for relevant articles, and studies published in Chinese were searched in the Wanfang China Medical Collections. The references of the retrieved studies were also reviewed. In addition, Google scholar was used to further confirm the literature search. RESULTS Fourteen studies were included comprising 1560 patients, of which 1190 (76.3%) received portoenterostomy. Meta-analysis did not reveal significant differences in either patient survival rate (odds ratio, 0.82) or graft survival rate (odds ratio, 1.11) over a 5-year follow-up between biliary atresia patients with and without a portoenterostomy procedure prior to liver transplantation; patients who received a prior portoenterostomy procedure had a higher risk of postoperative infection (odds ratio, 2.02). CONCLUSION Accumulated literature suggested that a prior portoenterostomy did not adversely affect outcomes of liver transplantation in children with biliary atresia.
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Affiliation(s)
- Panliang Wang
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Pengcheng Xun
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Ka He
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA.
| | - Wei Cai
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China; Shanghai Institute of Pediatric Research, Shanghai, China.
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Wada M, Nakamura H, Koga H, Miyano G, Lane GJ, Okazaki T, Urao M, Murakami H, Kasahara M, Sakamoto S, Ishizaki Y, Kawasaki S, Yamataka A. Experience of treating biliary atresia with three types of portoenterostomy at a single institution: extended, modified Kasai, and laparoscopic modified Kasai. Pediatr Surg Int 2014; 30:863-70. [PMID: 25064224 DOI: 10.1007/s00383-014-3551-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Generally, open portoenterostomy (PE) involves a wide extended anastomosis and all sutures are deep [extended PE (EP)]. In contrast, the anastomosis in Kasai's PE (KP), our modified open Kasai PE (MK), and our laparoscopic modified Kasai PE (lapMK) involve shallow suturing, especially at the 2 and 10 o'clock positions where the right and left bile ducts would be normally. We compared outcomes of 36 consecutive biliary atresia (BA) patients treated by three types of PE at a single institution during the period 2005-2014; EP (n = 13), MK (n = 11), and lapMK (n = 12). METHODS We compared age at PE, time taken to become jaundice-free (total bilirubin ≤1.2 mg/dL; JF time), proportion of JF subjects [JF ratio (JFR)], steroid dosage, incidence of cholangitis, postoperative liver function and CRP, presence of hypersplenism, requirement for liver transplantation (LTx), and JF survival with the native liver (JF+NL) as indicators of outcome. RESULTS Patient demographics, steroid dosage, JF time, incidence of cholangitis, presence of hypersplenism, operating time, blood loss and postoperative biochemistry were similar for all groups. However, JFR was significantly higher for lapMK (100 %) versus EP (46.2 %) (p < 0.05), but not for MK (81.8%) versus EP. Kaplan-Meier analysis showed survival with NL was significantly higher for lapMK (10/12: 83.3%: JF in 9; not JF in 1) and MK (9/11: 81.8 %: JF in all) versus EP (3/13: 23.1%: JF in all) (p < 0.05, respectively), but not for lapMK versus MK. JF+NL in both lapMK (9/12: 75.0%) and MK (9/11: 81.8%) were significantly higher compared with EP (3/13: 23.1%) (p < 0.05, respectively). Intraperitoneal adhesions were less pronounced at LTx in lapMK compared with MK or EP. CONCLUSIONS This study would suggest that depth of suturing during PE would appear to influence post-PE outcome. LapMK should be reconsidered as a valid treatment option for BA.
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Affiliation(s)
- Momoko Wada
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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14
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Squires RH, Ng V, Romero R, Ekong U, Hardikar W, Emre S, Mazariegos GV. Evaluation of the pediatric patient for liver transplantation: 2014 practice guideline by the American Association for the Study of Liver Diseases, American Society of Transplantation and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Hepatology 2014; 60:362-98. [PMID: 24782219 DOI: 10.1002/hep.27191] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 04/22/2014] [Indexed: 12/16/2022]
Affiliation(s)
- Robert H Squires
- Department of Pediatrics, University of Pittsburgh School of Medicine; Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
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Cimsit B, Yankol Y, Mecit N, Kanmaz T, Acarli K, Kalayoglu M. Calcification of Cryopreserved Arterial Graft Causing Delayed Obstruction of Portal Vein Flow After Liver Transplant. EXP CLIN TRANSPLANT 2014; 13:482-4. [PMID: 24919040 DOI: 10.6002/ect.2013.0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In patients with biliary atresia, portal vein problems may cause challenges for liver transplant. Interposition grafts have been used for vascular anastomoses in transplant recipients with varied success. A cryopreserved iliac artery graft was used for the reconstruction of the portal vein in a 29-month-old infant with biliary atresia. At 17 months after transplant, she developed upper gastrointestinal bleeding that was caused by portal vein occlusion because of vascular calcifications in the graft. Upper gastrointestinal endoscopy showed esophageal varices with fresh bleeding, and the varices were band ligated. At 3 months after the bleeding episode, the patient was asymptomatic and biochemical tests were normal. In summary, liver transplant with cryopreserved iliac artery graft may be complicated by calcifications and portal vein occlusion, and caution is advised in using this graft material for portal vein anastomoses.
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Affiliation(s)
- Bayindir Cimsit
- From the Department of Transplant Surgery, Istanbul Memorial Hospital, Istanbul, Turkey
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16
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Yamataka A. Laparoscopic Kasai portoenterostomy for biliary atresia. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 20:481-6. [PMID: 23572285 DOI: 10.1007/s00534-013-0607-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Minimally invasive surgery requires mastery of complex skills and exhaustive knowledge of anatomic variations but the patient benefits from excellent cosmesis, less requirement for analgesia and respiratory support, and a reduced incidence of postoperative morbidity, such as bowel adhesions and incisional hernias. Laparoscopic portoenterostomy is being performed with encouraging results after the open extended portoenterostomy procedure currently performed was revised to more closely resemble the original procedure developed by Kasai in the 1950s. Thus, the risk for damage to micro bile ducts around the porta hepatis is minimized because deep suturing and extensive dissection are eliminated.
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Affiliation(s)
- Atsuyuki Yamataka
- Department of Pediatric Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
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18
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Yamataka A, Lane GJ, Cazares J. Laparoscopic surgery for biliary atresia and choledochal cyst. Semin Pediatr Surg 2012; 21:201-10. [PMID: 22800973 DOI: 10.1053/j.sempedsurg.2012.05.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Minimally invasive surgery in children has evolved to the extent that complex procedures can be performed with safety and outcome comparable with open surgery, with the advantage of minimal scarring. Here we describe the latest laparoscopic techniques used by us at the Juntendo University Hospital, Japan, for treating biliary atresia and choledochal malformation, with presentation of our postoperative management and discussion of preliminary outcomes.
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Affiliation(s)
- Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan.
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19
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Rhu J, Jung SM, Choe YH, Seo JM, Lee SK. PELD score and age as a prognostic index of biliary atresia patients undergoing Kasai portoenterostomy. Pediatr Surg Int 2012; 28:385-91. [PMID: 22331203 DOI: 10.1007/s00383-012-3060-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE This study was designed to evaluate the validity of the pediatric end-stage liver disease (PELD) score as a prognostic index of native liver survival in biliary atresia before Kasai portoenterostomy. METHODS Medical records of 63 patients who underwent Kasai portoenterostomy at our hospital were reviewed retrospectively. Rate of jaundice clearance and cumulative survival with native liver were calculated. Patients who were alive and did not require transplantation until the last follow up were included in the native-liver survival group. And patients who underwent any event, defined as death without transplantation, transplantation or listing for transplantation, were included in the native-liver failure group. Cox analysis was done. RESULTS 10-year survival rate with native liver was 41.9%. PELD scores of ≥ 15 and an age at operation of ≥ 60 days were found to be significant risk factors of failure(P = 0.007, OR = 2.851 and P = 0.010, OR = 3.222, respectively). Furthermore, patients with both risk factors showed significantly higher risk of failure (P = 0.001, OR = 8.809). CONCLUSION Since failure rate is higher for patients with high PELD score and older age, these factors should be helpful in estimating the prognosis. And with high-risk patients, cautious monitoring and consultation should be made whether the liver fails and requires transplantation.
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Affiliation(s)
- Jinsoo Rhu
- Division of Pediatric Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea.
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20
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Lv Y, Wang Z, Zhu X, Shen Z, Yuan D, Miao X, Shi Y, Song Y. [Preliminary effect of Cyberknife radiosurgery in the treatment of 31 patients with advanced non-small cell lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2011; 14:329-34. [PMID: 21496431 PMCID: PMC5999721 DOI: 10.3779/j.issn.1009-3419.2011.04.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
背景与目的 射波刀是近年来新出现的一种立体定向放射治疗技术,具有大剂量、高精度和周围受照射的正常组织或是重要器官的范围小等优点,在治疗非小细胞肺癌(non-small cell lung cancer, NSCLC)方面取得了显著的效果。本研究旨在探讨射波刀(Cyberknife)治疗晚期NSCLC的疗效和安全性。 方法 在2009年3月-2010年3月间,我们应用射波刀治疗31例(34个肿瘤病灶)临床Ⅲ期-Ⅳ期的周围型NSCLC患者,其中Ⅲ期5例,Ⅳ期26例,腺癌15例,鳞癌12例,大细胞癌1例,腺鳞癌2例,不确定NSCLC 1例。28例患者联合了化疗。平均肿瘤体积67.2 cm3,处方总剂量36 Gy-60 Gy,分割2次-5次。等计量线65%-85%。治疗后1-2个月复查胸部CT,观察近期疗效,每3个月随访一次。 结果 2例完全缓解,16例部分缓解,7例稳定,6例进展,总体有效率达58%,疾病控制率为81%。所有患者治疗耐受性良好,最主要的不良反应表现为乏力,无4级或是4级以上的不良反应发生。 结论 射波刀治疗晚期NSCLC安全性好,有较好的近期疗效,不良反应轻,患者易耐受。但是远期疗效有待进一步随访。
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Affiliation(s)
- Yanling Lv
- Department of Respiratory Disease, Nanjing Clinical school of Southern Medical University, Nanjing General Hospital Of Nanjing Military Command, Nanjing, China
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Lao OB, Larison C, Garrison M, Healey PJ, Goldin AB. Steroid use after the Kasai procedure for biliary atresia. Am J Surg 2010; 199:680-4. [PMID: 20466116 DOI: 10.1016/j.amjsurg.2010.01.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Revised: 01/19/2010] [Accepted: 01/19/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to describe patients undergoing the Kasai procedure at children's hospitals, evaluate outcomes, and analyze the association of these outcomes with systemic steroid use. METHODS Biliary atresia patients (International Classification of Diseases, Ninth Revision, code 751.61) who underwent Kasai procedures at freestanding children's hospitals in the Pediatric Health Information System database from 2003 to 2008 were identified. Descriptive characteristics were examined, and regression analyses were used to determine whether postoperative steroid use was associated with length of stay, mortality, or cholangitis. RESULTS Of the 516 children identified (40% male, 50% aged < 2 months), 239 (46%) received perioperative steroids. The mean total and postoperative lengths of stay were 14.5 +/- 19.7 and 11.3 +/- 16.3 days, respectively. Postoperative steroid use was significantly associated with a 3.5-day decrease in postoperative length of stay (95% confidence interval, .03-6.97). CONCLUSIONS Perioperative steroids after the Kasai procedure are associated with shorter postoperative length of stay. Work is needed to ascertain whether this relationship is causal.
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Affiliation(s)
- Oliver B Lao
- Department of Surgery, Seattle Children's Hospital, Seattle, WA, USA.
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22
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Khalil BA, Perera MTPR, Mirza DF. Clinical practice: management of biliary atresia. Eur J Pediatr 2010; 169:395-402. [PMID: 20020156 DOI: 10.1007/s00431-009-1125-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 11/30/2009] [Indexed: 12/13/2022]
Abstract
Biliary atresia is a rare, serious and challenging disease in newborn children. Its aetiology remains unknown. Optimal management at specialist centres with resultant better overall outcomes is achieved through a multidisciplinary team approach. The Kasai portoenterostomy performed early in life remains the only surgical repair procedure. Two thirds of patients will clear their jaundice after a Kasai procedure, but only about one third will retain their livers after the first decade of life. Failure of this procedure leaves liver transplantation as the only chance for survival, and this disease is the commonest indication for liver transplantation in children. With modern medical care and refinements in surgical techniques, survival after either or both of these procedures is about 90%. Early referral to specialist centres and long-term specialist care remains the key to successful treatment of this condition.
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Affiliation(s)
- Basem A Khalil
- The Liver Unit, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK
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Erlichman J, Hohlweg K, Haber BA. Biliary atresia: how medical complications and therapies impact outcome. Expert Rev Gastroenterol Hepatol 2009; 3:425-34. [PMID: 19673629 DOI: 10.1586/egh.09.30] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Biliary atresia (BA) is a progressive fibro-obliterative disease of the extrahepatic biliary tree that presents with biliary obstruction in the neonatal period. Untreated, BA is a uniformly fatal disease and, yet, even with our existing therapies, at least 50% of children with BA will undergo liver transplantation by the age of 2 years. Current treatment strategies are, at best, palliative; they focus on prompt diagnosis, supportive nutritional care and interventions for sequelae. The purpose of this article is to discuss the current treatment paradigm for BA and to assess the impact these strategies have on outcomes. As more children with BA survive into adulthood with their native liver, it is important to understand which factors predict good and poor outcomes.
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Affiliation(s)
- Jessi Erlichman
- Division of GI, Hepatology and Nutrition, The Childrens' Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104, USA
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Nemati M, Rafeey M, Shakeri AB. Ultrasound findings in biliary atresia: the role of triangular cord sign. Pak J Biol Sci 2009; 12:95-7. [PMID: 19579927 DOI: 10.3923/pjbs.2009.95.97] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this prospective study, 49 infants with prolonged jaundice, were studied between January 2005 to April 2007 in Tabriz Children's Hospital. All of these infants were evaluated with ultrasonography and isotopscan and finally biopsy was done in all of them under guide of sonography. In their sonographic evaluation, absence or presence of gall bladder, its size and also its evacuation after feeding was checked and beside this triangular cord sign was controlled. The PPV and specificity of triangular cord sign in diagnosis of extrahepatic biliary atresia (EHBA) was 100% but its NPV was only 78.5%. The overall accuracy, PPV, NPV, specificity and sensitivity ofultrasonographic findings in diagnosis of EHBA was about 94, 92, 94, 97 and 86%. Ultrasonography is a reliable screening method in early diagnosis of EHBA and triangular cord sign increases its accuracy especially its specificity.
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Affiliation(s)
- M Nemati
- Department of Radiology, Tabriz University (Medical Sciences), Tabriz, Iran
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Haber BA, Erlichman J, Loomes KM. Recent advances in biliary atresia: prospects for novel therapies. Expert Opin Investig Drugs 2009; 17:1911-24. [PMID: 19012506 DOI: 10.1517/13543780802514120] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Biliary atresia (BA) is a progressive fibro-obliterative disease of the extrahepatic biliary tree that presents with biliary obstruction before 2 months of age. Untreated BA is a uniformly fatal disease and even with our current therapies only 50% of children with BA will be transplant-free by 2 years of age. Despite descriptions of this disorder dating back to the 1800s our current therapies are palliative. They focus on prompt diagnosis, supportive nutritional care and interventions for sequelae. OBJECTIVE To present the literature supporting current treatment strategies and potential future therapies. METHOD Each of the aspects of care is described and the literature about nuances of care is provided. CONCLUSION Therapies will not improve outcomes until novel treatments are introduced, such as those suggested, which may intervene in the inflammatory or fibrotic steps of the disease process.
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Affiliation(s)
- Barbara A Haber
- Associate Professor of Pediatrics The Childrens Hospital of Philadelphia, Division of GI, Hepatology & Nutrition, Philadelphia, PA 19104, USA.
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Abstract
Extrahepatic biliary atresia (EHBA), an inflammatory sclerosing cholangiopathy, is the leading indication for liver transplantation in children. The cause is still unknown, although possible infectious, genetic, and immunologic etiologies have received much recent focus. These theories are often dependent on each other for secondary or coexisting mechanisms. Concern for EHBA is raised by a cholestatic infant, but the differential diagnosis is large and the path to diagnosis remains varied. Current treatment is surgical with an overall survival rate of approximately 90%. The goals of this article are to review the important clinical aspects of EHBA and to highlight some of the more recent scientific and clinical developments contributing to our understanding of this condition.
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Affiliation(s)
- Mikelle D. Bassett
- Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA
| | - Karen F. Murray
- Division of Gastroenterology and Nutrition, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA
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Petersen C, Harder D, Melter M, Becker T, Wasielewski RV, Leonhardt J, Ure BM. Postoperative high-dose steroids do not improve mid-term survival with native liver in biliary atresia. Am J Gastroenterol 2008; 103:712-9. [PMID: 18177447 DOI: 10.1111/j.1572-0241.2007.01721.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Postoperative adjuvant steroid treatment is reported to improve jaundice-free survival in biliary atresia (BA) patients and to reduce the need for early liver transplantation. However, evidence of all retrospective studies is very limited, although high-dose corticosteroids were favored. The aim of this dosage finding study was to test the most promising corticosteroid protocol in a smaller but representative series, in order to optimize the settings of upcoming prospective and long-term multicenter studies. METHODS Our prospective single-center and open-labeled pilot study on high-dose steroids included 49 consecutive BA patients. Basic data of the study group were not different from 29 controls. In the study group, 20 consecutive patients were treated after the Kasai with methylprednisolone (10 mg/kg day 1 to 5 and 1 mg/kg day 6 to 28). RESULTS Overall survival with native liver was 63% after 6 months and 31% after 2 yr, with no statistical difference between the study and control groups. After 2 yr, 27% of all patients were still jaundice-free. With regard to predictive parameters, we found, 6 months after the Kasai, bilirubin < 20 micromol/L as highly sensitive (97%) and specific (93%) for jaundice-free survival with native liver. CONCLUSIONS In contrast to previous reports, this pilot study shows that high-dose steroid pulses after Kasai procedure are not effective in postoperative adjuvant therapy protocols and should be avoided in upcoming multicenter steroid studies. Therefore, we recommend extended and randomized multicenter studies to pre-evaluate the supposed effectiveness of alternative steroid protocols, by comparing, 6 months after the Kasai procedure, the number of patients with normal bilirubin.
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Affiliation(s)
- Claus Petersen
- Department of Pedatric Surgery, Hannover Medical School, Hannover, Germany
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