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Efficacy of and prognosis after steroid pulse therapy in patients with poor reduction of jaundice after laparoscopic Kasai portoenterostomy

  • Yujiro TanakaEmail author
  • Chiyoe Shirota
  • Takahisa Tainaka
  • Wataru Sumida
  • Kazuo Oshima
  • Satoshi Makita
  • Tomoko Tanaka
  • Yukiko Tani
  • Kosuke Chiba
  • Hiroo Uchida
Original Article
  • 17 Downloads

Abstract

Purpose

High-dose postoperative steroid therapy after Kasai portoenterostomy is reported to improve jaundice clearance and a strong anti-inflammatory activity might prevent fibrous tissue formation which is often observed at the porta hepatis in revision surgery. We started steroid pulse therapy for the patients with cessation of decrease in jaundice and aimed to evaluate the efficacy in this study.

Methods

The demographics and outcomes of patients who underwent laparoscopic Kasai portoenterostomy and received steroid pulse therapy within 2 months postoperatively between September 2014 and December 2018 were retrospectively reviewed; the therapy was determined successful when the serum total bilirubin level decreased to or below two-thirds of the pre-therapy level after 2 weeks. Patient data in the successful group were compared with those in the unsuccessful group.

Results

Steroid pulse therapy was successful in seven of 16 patients (43.8%). The percentage of patients whose serum total bilirubin level decreased to normal was significantly higher in the successful group at 3 months (85.7% vs. 11.1%, P = 0.0028) and after all (100% vs. 33.3%, P = 0.011).

Conclusions

Steroid pulse therapy was effective for some patients. Unsuccessful cases may have little chances of jaundice clearance; revision Kasai portoenterostomy would be a good option.

Keywords

Biliary atresia Steroid pulse therapy Kasai portoenterostomy Revision surgery Endoscopic surgery 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants included in this study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Yujiro Tanaka
    • 1
    Email author
  • Chiyoe Shirota
    • 1
  • Takahisa Tainaka
    • 1
  • Wataru Sumida
    • 1
  • Kazuo Oshima
    • 1
  • Satoshi Makita
    • 1
  • Tomoko Tanaka
    • 1
  • Yukiko Tani
    • 1
  • Kosuke Chiba
    • 1
  • Hiroo Uchida
    • 1
  1. 1.Department of Pediatric SurgeryNagoya University Graduate School of MedicineNagoyaJapan

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