title: HIDA, percutaneous transhepatic cholecysto-cholangiography and liver biopsy in infants with persistent jaundice: can a combination of PTCC and liver biopsy reduce unnecessary laparotomy?
abstract: BACKGROUND
  Historically, HIDA is the initial diagnostic test in the evaluation of biliary atresia (BA). Non-excreting HIDA scans can yield false-positive results leading to negative laparotomy.
  
  
  OBJECTIVE
  Cholestatic infants must be evaluated promptly to exclude biliary atresia (BA) and other treatable hepatic conditions. Intraoperative cholangiogram (IOC) is the gold standard for diagnosing BA, but requires surgical intervention. Percutaneous transhepatic cholecysto-cholangiography (PTCC) and liver biopsy are less invasive and have been described in small case series. We hypothesized that PTCC and liver biopsy effectively exclude BA, thus avoiding unnecessary IOC.
  
  
  METHODS
  Retrospective review of cholestatic infants who underwent PTCC, biopsy or cholescintigraphy at a tertiary children's hospital from August 1998 to January 2009. Group differences were evaluated and the receiver operator curve and safety of PTCC determined.
  
  
  RESULTS
  One-hundred twenty-eight cholestatic infants were reviewed. Forty-six (36%) underwent PTCC. Forty-one out of 46 (89%) had simultaneous PTCC and liver biopsy. PTCC was completed successfully in 19/23 (83%) children despite a small or absent GB on initial US. Negative laparotomy rate was 1/6 (17%) for simultaneous PTCC/liver biopsy. Complications occurred in 4/46 including bleeding (n=2), fever with elevated transaminases (n=1) and oxygen desaturations (n=1).
  
  
  CONCLUSIONS
  PTCC, particularly when performed in combination with simultaneous liver biopsy, effectively excludes BA in cholestatic infants with acceptable morbidity. PTCC can frequently be performed when a contracted gallbladder is seen on initial US exam. Negative laparotomy rate is lowest when PTCC is coupled with simultaneous liver biopsy.
authors.affiliation: Department of Pediatrics, Division of Pediatric Gastroenterology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA.
authors.forename: M Kyle
authors.initials: MK
authors.lastname: Jensen
authors.forename: Vincent F
authors.initials: VF
authors.lastname: Biank
authors.forename: David C
authors.initials: DC
authors.lastname: Moe
authors.forename: Pippa M
authors.initials: PM
authors.lastname: Simpson
authors.forename: Shun Hwa
authors.initials: SH
authors.lastname: Li
authors.forename: Grzegorz W
authors.initials: GW
authors.lastname: Telega
mesh_terms: D001706:Biopsy / Q000706:statistics & numerical data*; D002758:Cholangiography / Q000706:statistics & numerical data*; D002765:Cholecystography / Q000706:statistics & numerical data*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007098:Imino Acids; D007223:Infant; D007231:Infant, Newborn; D007565:Jaundice / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery; D007813:Laparotomy / Q000706:statistics & numerical data*; D008297:Male; D015995:Prevalence; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014922:Wisconsin / Q000453:epidemiology
chemical_list: D007098:Imino Acids; D019275:Radiopharmaceuticals; C049470:lidofenin