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Comparison between cystic biliary atresia and choledochal cyst: a clinical controlled study

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Abstract

Purpose

It is difficult to distinguish cystic biliary atresia (CBA) from choledochal cyst (CC) before intraoperative cholangiography in neonates or young infants because of the similar ultrasonographic patterns and clinical manifestations. This study is to investigate the difference of clinical parameters between CBA and CC.

Methods

96 patients with cyst at hepatic hilum whose ages were less than 120 days during the period from Jan’2013 to Nov’2015 were retrospectively studied, they were divided into CBA group and CC group by intraoperative cholangiography, there were 29 cases of CBA and 67 cases of CC. It was compared and analyzed on laboratory data, preoperative ultrasonographic features, intraoperative cholangiography and histopathological results between the two groups. Data were quoted as means ± standard deviation (SD) or median (range), Student’s t test, non-parametric test and χ2 test were used as appropriate. P < 0.05 was considered as significant statistical difference.

Results

CBA group and CC group were comparable for the operative age (51.76 ± 23.99 days vs. 50.03 ± 26.38 days, P = 0.76), weight (4.60 ± 0.75 kg vs. 4.44 ± 1.03 kg, P = 0.46) and sex proportion (M/F: 9/20 vs. 20/47, P = 0.91). there were significant differences (CBA vs. CC) in ALT [59(3–375) vs. 30 (6–247) IU/L, P < 0.001], AST [140(30–694) vs. 44(18–410) IU/L, P < 0.001], T-Bil [190 (107–326) vs.87(5–310) μmol/L, P < 0.001], D-Bil [85 (31–174) vs.14(1–122) μmol/L, P < 0.001] and TBA [112 (23–269) vs.9(1–337) μmol/L, P < 0.001]. There was insignificant statistical difference in GGT [332(112–2154) vs. 226(21–1810) IU/L, P = 0.099] between CBA group and CC group. The cyst size in CBA group was obviously smaller than CC group (the maximum longitudinal diameter: 2.52 ± 1.16 cm vs. 4.71 ± 2.23 cm, P < 0.001; the maximum transverse diameter: 1.64 ± 0.75 cm vs. 3.41 ± 1.79 cm, P < 0.001). Significant differences presented in preoperative ultrasonographic features and histopathological results between the two groups.

Conclusion

CBA should be suspected if ultrasonography indicates small cyst with characteristic manifestations of BA and elevated laboratory data. GGT was an insensitive indicator in distinguishing CBA from CC. Cholangiography should be done for the suspected CBA patients as soon as possible to confirm the diagnosis and have surgical intervention timely.

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Funding

The funding has been recevied from capital institute of pediatrics hospital’s ethical board with Grant no. SHERLL2013064.

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Authors and Affiliations

  1. Department of Neonatal Surgery, Xi’an Children’s Hospital, Xi’an, Shaanxi, China

    Pu Yu & Yong Kang Pan

  2. Department of General Surgery, Capital Institute of Pediatrics, Beijing, China

    Ning Dong & Long Li

Authors
  1. Pu Yu
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  2. Ning Dong
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  3. Yong Kang Pan
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  4. Long Li
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Correspondence to Long Li.

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The authors declare that they have no conflicts of interest.

Ethical approval

This study was approved by the Capital Institute of Pediatrics hospital’s ethical board (SHERLL2013064).

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This article does not contain any studies with animals performed by any of the authors.

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The individual written informed consent was waived because of the retrospective design.

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Yu, P., Dong, N., Pan, Y.K. et al. Comparison between cystic biliary atresia and choledochal cyst: a clinical controlled study. Pediatr Surg Int 38, 109–114 (2022). https://doi.org/10.1007/s00383-021-05004-y

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