Endoscopic retrograde cholangiopancreaticography prior to explorative laparotomy avoids unnecessary surgery in patients suspected for biliary atresia.
OBJECTIVE
Timely diagnosis of biliary atresia (BA) requires key investigations that are less invasive but as accurate as possible. Non-invasive imaging preselects patients before explorative laparotomy is performed. The purpose of this prospective study was to evaluate the accuracy of endoscopic retrograde cholangiopancreaticography (ERCP) in these patients and to discuss its relevance to future diagnostic guidelines in neonatal jaundice.


METHODS
Over a 7-year period, ERCP was routinely performed in cholestatic patients less than 6 months of age suspected for an extrahepatic origin of cholestasis, most likely BA. Endoscopic diagnosis was correlated with intraoperative findings.


RESULTS
In 140 consecutive patients (mean age: 60 days; weight: 4 kg), ERCP excluded BA in 34 (25%) but failed in 18 newborns (13%) for technical reasons. The average procedure time was 23 min, and no severe complications occurred. Explorative laparotomy was performed in 106 patients and revealed BA in 80 cases. In this series, the sensitivity of ERCP for diagnosing biliary atresia was 92% and specificity was 73%.


CONCLUSIONS
In preselected patients, ERCP is not an alternative to non-invasive imaging, but it avoids unnecessary surgical procedures in almost 25% of the cases. Hence, ERCP is recommended prior to explorative laparotomy in all patients suspected for BA.
Petersen
Claus
C
Department of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. petersen.claus@mh-hannover.de
Meier
Peter N
PN
Schneider
Andrea
A
Turowski
Carmen
C
Pfister
Eva D
ED
Manns
Michael P
MP
Ure
Benno M
BM
Wedemeyer
Jochen
J
D001656:Biliary Atresia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D001662:Biliary Tract Surgical Procedures; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data; D001651:Cholestasis, Extrahepatic / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D007813:Laparotomy; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity