Efficacy of and prognosis after steroid pulse therapy in patients with poor reduction of jaundice after laparoscopic Kasai portoenterostomy
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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.
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.
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).
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.
KeywordsBiliary atresia Steroid pulse therapy Kasai portoenterostomy Revision surgery Endoscopic surgery
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interest.
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 was obtained from all participants included in this study.
- 7.Bezerra JA, Spino C, Magee JC, Shneider BL, Rosenthal P, Wang KS, Erlichman J, Haber B, Hertel PM, Karpen SJ, Kerkar N, Loomes KM, Molleston JP, Murray KF, Romero R, Schwarz KB, Shepherd R, Suchy FJ, Turmelle YP, Whitington PF, Moore J, Sherker AH, Robuck PR, Sokol RJ, Childhood Liver Disease R, Education N (2014) Use of corticosteroids after hepatoportoenterostomy for bile drainage in infants with biliary atresia: the START randomized clinical trial. JAMA 311:1750–1759. https://doi.org/10.1001/jama.2014.2623 CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Suzuki T, Hashimoto T, Kondo S, Sato Y, Hussein MH (2010) Evaluating patients’ outcome post-Kasai operation: a 19-year experience with modification of the hepatic portoenterostomy and applying a novel steroid therapy regimen. Pediatr Surg Int 26:825–830. https://doi.org/10.1007/s00383-010-2637-y CrossRefPubMedGoogle Scholar
- 13.Yokota K, Uchida H, Tanano A, Shirota C, Tainaka T, Hinoki A, Murase N, Oshima K, Shirotsuki R, Chiba K (2016) Steroid pulse therapy prevents restenosis following balloon dilatation for esophageal stricture. Pediatr Surg Int 32:875–879. https://doi.org/10.1007/s00383-016-3939-5 CrossRefPubMedGoogle Scholar
- 15.Pang SY, Dai YM, Zhang RZ, Chen YH, Peng XF, Fu J, Chen ZR, Liu YF, Yang LY, Wen Z, Yu JK, Liu HY (2018) Autoimmune liver disease-related autoantibodies in patients with biliary atresia. World J Gastroenterol 24:387–396. https://doi.org/10.3748/wjg.v24.i3.387 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Alonso EM, Ye W, Hawthorne K, Venkat V, Loomes KM, Mack CL, Hertel PM, Karpen SJ, Kerkar N, Molleston JP, Murray KF, Romero R, Rosenthal P, Schwarz KB, Shneider BL, Suchy FJ, Turmelle YP, Wang KS, Sherker AH, Sokol RJ, Bezerra JA, Magee JC, Chi LN (2018) Impact of steroid therapy on early growth in infants with biliary atresia: the multicenter steroids in biliary atresia randomized trial. J Pediatr 202(179–185):e174. https://doi.org/10.1016/j.jpeds.2018.07.002 CrossRefGoogle Scholar