Abstract
The objective of this study was to evaluate the feasibility, safety, and diagnostic accuracy of percutaneous cholecystocholangiography (PCC) in cases of conjugated hyperbilirubinemia in which biliary atresia (BA) could not be diagnosed or ruled out based on clinical, radiological, and histopathological findings. This was a retrospective, chart review of all cholestatic infants who underwent PCC within the last 5 y. PCC was performed via the transhepatic route using 23-g needle. The patency of both the proximal and distal biliary trees was assessed. PCC was technically feasible in 12/13 (92.3%) of infants without any procedure-related complications. PCC demonstrated proximal and distal biliary patencyin 7/12 (58.3%) infants, thereby avoiding unnecessary laparotomy in them. PCC failed to demonstrate biliary patency in 5 infants; of which, 4 were confirmed as cases of BA on laparotomy. PCC can correctly differentiate BA from non-BA cases of conjugated hyperbilirubinemia preoperatively, reducing the negative laparotomy rates.
References
Fawaz R, Baumann U, Ekong U, et al. Guideline for the evaluation of cholestatic jaundice in infants: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2017;64:154–68.
Shteyer E, Wengrower D, Benuri-Silbiger I, Gozal D, Wilschanski M, Goldin E. Endoscopic retrograde cholangiopancreatography in neonatal cholestasis. J Pediatr Gastroenterol Nutr. 2012;55:142–5.
Liu B, Cai J, Xu Y, et al. Three-dimensional magnetic resonance cholangiopancreatography for the diagnosis of biliary atresia in infants and neonates. PLoS ONE. 2014;9:e88268.
Jensen MK, Biank VF, Moe DC, Simpson PM, Li SH, Telega GW. HIDA, percutaneous transhepatic cholecysto-cholangiography and liver biopsy in infants with persistent jaundice: can a combination of PTCC and liver biopsy reduce unnecessary laparotomy? Pediatr Radiol. 2012;42:32–9.
Nwomeh BC, Caniano DA, Hogan M. Definitive exclusion of biliary atresia in infants with cholestatic jaundice: the role of percutaneous cholecysto-cholangiography. Pediatr Surg Int. 2007;23:845–9.
Lee SY, Kim GC, Choe BH, et al. Efficacy of US-guided percutaneous cholecystocholangiography for the early exclusion and type determination of biliary atresia. Radiology. 2011;261:916–22.
Meyers RL, Book LS, O’Gorman MA, et al. Percutaneous cholecysto-cholangiography in the diagnosis of obstructive jaundicee in infants. J Pediatr Surg. 2004;39:16–8.
Zhou LY, Chen SL, Chen HD, et al. Percutaneous US-guided cholecystocholangiography with microbubbles for assessment of infants with US findings equivocal for biliary atresia and gallbladder longer than 1.5 cm: a pilot study. Radiology. 2018;286:1033–9.
Hashimoto T, Yura J. Percutaneous transhepatic cholangiography (PTC) in biliary atresia with special reference to the structure of the intrahepatic bile ducts. J Pediatr Surg. 1981;16:22–5.
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BBL, RK, and SA conceptualized the research paper; AA, VG, PV, and BBL collected the data; AM performed the procedures; AA, VG, and BBL prepared the first draft. All authors reviewed the manuscript, provided critical inputs, and approved the final version. SA will act as the guarantor for this paper.
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Ashritha, A., Gautam, V., Lal, B.B. et al. Percutaneous Cholecystocholangiography—A Tool to Conclusively Exclude Biliary Atresia. Indian J Pediatr 89, 1144–1147 (2022). https://doi.org/10.1007/s12098-022-04354-2
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DOI: https://doi.org/10.1007/s12098-022-04354-2