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Early differential diagnosis methods of biliary atresia: a meta-analysis

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Abstract

Purpose

To evaluate the accuracy of early differential diagnosis methods of biliary atresia in patients with infantile cholestasis.

Methods

We searched PubMed, EMBASE and the Web of Science databases for articles evaluated the early differential diagnosis methods of biliary atresia. The methodological quality of each study was assessed with version 2 of the Quality Assessment of Diagnostic Accuracy Studies tool. Two reviewers extracted data independently. Pooled sensitivity, specificity, positive likelihood ratio (LR +), negative likelihood ratio (LR −), diagnostic odds ratio (DOR) with 95% CIs were calculated to assess each diagnosis method.

Results

A total of 38 articles were included. Summary sensitivity and specificity were 77% (95% CI 74–80%) and 93% (95% CI 91–94%), respectively, for B-US in 23 studies; 96% (95% CI 92–98%) and 58% (95% CI 51–65%), respectively, for MRCP in five studies; 87% (95% CI 82–91%) and 78% (95% CI 74–82%), respectively, for acholic stool in seven studies; 84% (95% CI 78–89%) and 97% (95% CI 97–98%), respectively, for serum liver function test in seven studies; 96% (95% CI 94–97%) and 73% (95% CI 70–76%), respectively, for hepatobiliary scintigraphy in 18 studies; 98% (95% CI 96–99%) and 93% (95% CI 89–95%), respectively, for percutaneous liver biopsy in 11 studies.

Conclusion

The accuracy rate of percutaneous liver biopsy is better than all of the noninvasive methods. Take into consideration the advantages and disadvantages of the six methods, combination of multidisciplinary noninvasive diagnosis methods is the first choice for differential diagnosis of BA from other causes of neonatal cholestasis.

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Acknowledgements

We thank Patrick Chung and Professor Vincent for their advices on this study.

Funding

This study was funded by the National Science Foundation of China (Grant Number 81570471) and the Tianjin Health Bureau special grant (Grant Number 14KG129).

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Authors and Affiliations

  1. Department of Pediatric Surgery, Tianjin Children’s Hospital, Tianjin, 300134, China

    Li Wang, Yuan Yang, Yang Chen & Jianghua Zhan

  2. Tianjin Pediatrics Research Institute, Tianjin, 300134, China

    Jianghua Zhan

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  1. Li Wang
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  2. Yuan Yang
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Correspondence to Jianghua Zhan.

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Wang, L., Yang, Y., Chen, Y. et al. Early differential diagnosis methods of biliary atresia: a meta-analysis. Pediatr Surg Int 34, 363–380 (2018). https://doi.org/10.1007/s00383-018-4229-1

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