Selective use of endoscopic retrograde cholangiopancreatography in the diagnosis of biliary atresia in infants younger than 100 days.
OBJECTIVE
We investigated the role and safety of endoscopic retrograde cholangiopancreatography (ERCP) in diagnosing biliary atresia (BA) in prolonged neonatal cholestasis, when standard workup was inconclusive.


METHODS
We reviewed notes of 48 cholestatic infants younger than 100 days undergoing ERCP from 1997 to 2007.


RESULTS
Amongst approximately 3300 infants evaluated for liver disease during the study, 224 (6.8%) were diagnosed with BA. Forty-eight children underwent ERCP. Findings at liver biopsy (n=47) included nonspecific cholestasis (n=19, 40%), giant-cell hepatitis (n=12, 26%), "large bile duct obstruction" (n=9, 19%) in the presence of pigmented stools, and mixed cholestatic/hepatitic features (n=7, 15%). ERCP demonstrated a patent biliary tree in 20 infants (42%). BA was confirmed at exploratory laparotomy in all 3 infants (6%) in whom cannulation failed. The remaining 25 infants (52%) also proceeded to exploratory laparotomy, in which BA was confirmed in 22 (46%). Amongst the 20 children in whom ERCP ruled out BA, 8 (17%) had normal biliary anatomy, whilst 12 (25%) had an abnormal biliary tree, including 6 (12.5%) with neonatal sclerosing cholangitis. After ERCP none developed clinical pancreatitis or peritonitis.


CONCLUSIONS
ERCP is a safe procedure for diagnosing BA even in the smallest infants with high positive and negative predictive values.
Shanmugam
Naresh P
NP
Paediatric Liver Centre, Institute of Liver Studies, Department of Radiology, King's College Hospital, London, UK.
Harrison
Phillip M
PM
Devlin
John
J
Peddu
Praveen
P
Knisely
A S
AS
Davenport
Mark
M
Hadzić
Nedim
N
D001656:Biliary Atresia / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D001659:Biliary Tract / Q000473:pathology*; D001706:Biopsy; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D002779:Cholestasis / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007813:Laparotomy / Q000379:methods; D008107:Liver Diseases / Q000209:etiology*