title: Endoscopic retrograde cholangiopancreaticography prior to explorative laparotomy avoids unnecessary surgery in patients suspected for biliary atresia.
abstract: 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.
authors.affiliation: Department of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. petersen.claus@mh-hannover.de
authors.forename: Claus
authors.initials: C
authors.lastname: Petersen
authors.forename: Peter N
authors.initials: PN
authors.lastname: Meier
authors.forename: Andrea
authors.initials: A
authors.lastname: Schneider
authors.forename: Carmen
authors.initials: C
authors.lastname: Turowski
authors.forename: Eva D
authors.initials: ED
authors.lastname: Pfister
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
authors.forename: Benno M
authors.initials: BM
authors.lastname: Ure
authors.forename: Jochen
authors.initials: J
authors.lastname: Wedemeyer
mesh_terms: 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