SIR 2024
Pediatric Interventions
Ahmed Mabrouk, BS
Medical Student
University of Wisconsin
Financial relationships: Full list of relationships is listed on the CME information page.
Jonathan Swanson, MD, MBA
Professor of Radiology
University of Wisconsin
Disclosure information not submitted.
Eric Monroe, MD (he/him/his)
Associate Professor
University of Wisconsin
Financial relationships: Full list of relationships is listed on the CME information page.
Timely intervention via kasai portoenterostomy for confirmed cases of biliary atresia (BA) is important to avert progression to cirrhosis and liver failure {1}. Traditionally, hepatobiliary iminodiacetic acid (HIDA) scan has been the first diagnostic test of choice but false positive rates may lead to high rates of negative laparotomy {2}. Percutaneous cholecystocholangiography (PTCC) is effective at excluding BA {3}. Evaluation with liver biopsy combined with PTCC in place of HIDA may provide an expedited workflow and decrease the rates of false positive and indeterminate results. The objective of this study was to conduct a retrospective analysis to model the temporal implications of the different workflows used in the evaluation of suspected BA cases.
Materials and methods: We retrospectively identified 52 patients that underwent evaluation for BA at a tertiary children's hospital from April 2013 to July 2023. These patients underwent heterogenous pathways for the diagnosis or exclusion of BA that include a baseline ultrasound followed by either HIDA alone, HIDA and a liver biopsy, HIDA and PTCC combined with a liver biopsy, or PTCC combined with a liver biopsy. The time in days from the initial suspicion of BA, defined as the presence of clinical jaundice, abnormal LFTs, or alcoholic stools, to the diagnosis or exclusion (TDE) was recorded.
Results: Of 52 patients displaying signs concerning for BA, 23 underwent a HIDA alone, resulting in an average time to diagnosis or exclusion in days of 20.3 ± 16.3 days. 7 patients underwent a HIDA and a liver biopsy, resulting in a TDE of 21.6 ± 12.1 days. 16 patients underwent a HIDA and PTCC with a liver biopsy, resulting in a TDE of 28.4 ± 27.5 days. 6 patients underwent a PTCC with a liver biopsy, resulting in a TDE of 8.0 ± 2.6 days. The difference in TDE between patients that underwent HIDA and liver biopsy versus those that underwent PTCC with a liver biopsy was 13.6 days (p = 0.03). Of the 16 patients that underwent HIDA followed by PTCC, 10 received inconclusive or suggestive findings of BA on HIDA that was then subsequently ruled out by PTCC.
Conclusion: Evaluation with PTCC in place of HIDA can lead to a faster and more definitive diagnosis or exclusion of BA, with important implications for both health care expenditures and timeliness of surgical correction.