title: Cholestasis associated with small bowel atresia: do we always need to investigate?
abstract: OBJECTIVE
  Cholestasis occurs frequently in patients with small bowel atresia (SBA) and is often attributed to prolonged parental nutrition. When severe or prolonged, patients may undergo unnecessary intensive or invasive investigation. We characterized cholestasis and analyzed the pertinence of investigating this patient population.
  
  
  METHODS
  With Research Ethics Board approval, patients with SBA between 1996 and 2005 were retrospectively reviewed. Demographics, location of atresia, operative findings, complications, investigations, resumption of feeding, duration of prolonged parental nutrition, and follow-up information were examined. Cholestasis was evaluated for incidence, severity, and evolution.
  
  
  RESULTS
  Fifty-five patients (29 male, 26 female), with a median gestational age and birth weight of 36 weeks and 2025 g, respectively, were reviewed. Care was withdrawn for 2 patients before repair. For the remaining 53 patients, SBA were duodenal atresia in 18, jejunoileal atresia in 32, and multiple atresia in 3. Of 53, 24 (45%) patients developed cholestasis postoperatively (direct/total bilirubin >20%). All patients with short bowel (4) and 60% (6/10) of patients with a delay of enteral feeding more than 14 days postoperatively had cholestasis. Ten patients (36%) proceeded with in-depth evaluations for cholestasis, with 8 (28%) undergoing liver biopsy. No patient had biliary atresia. No deaths were related to isolated cholestasis/cirrhosis. Cholestasis resolved spontaneously in all the survivors.
  
  
  CONCLUSIONS
  Small bowel atresia is frequently associated with postoperative cholestasis that will resolve with time. We recommend a more selective and expectant approach to SBA-associated cholestasis to minimize unnecessary investigations.
authors.affiliation: Division of Pediatric Surgery, The Montreal Children's Hospital, Montréal, Québec, Canada H3H 1P3.
authors.forename: Ann
authors.initials: A
authors.lastname: Aspirot
authors.forename: Wendy
authors.initials: W
authors.lastname: Su
authors.forename: Hélène
authors.initials: H
authors.lastname: Flageole
authors.forename: Pramod S
authors.initials: PS
authors.lastname: Puligandla
authors.forename: Kenneth
authors.initials: K
authors.lastname: Shaw
authors.forename: Jean-Martin
authors.initials: JM
authors.lastname: Laberge
mesh_terms: D002779:Cholestasis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007409:Intestinal Atresia / Q000150:complications*; D007421:Intestine, Small; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors