title: Outcome of partial internal biliary diversion for intractable pruritus in children with cholestatic liver disease.
abstract: OBJECTIVE
  Children with cholestatic disorders have undergone liver transplantation for intractable pruritus unresponsive to medical therapy even in the absence of liver failure. Biliary diversion procedures interrupt the entero-hepatic circulation of bile acids allowing them to be excreted in the feces thereby lowering the total bile acid pool. We evaluated the outcome of partial internal biliary diversion (PIBD) in children with intractable pruritus from inherited cholestatic disorders.
  
  
  METHODS
  The records of children who underwent PIBD over a 4-year period were reviewed for etiology of liver disease, demographic data, preoperative and postoperative biochemical profile and improvement of pruritus. Standard statistical methods were used for analysis.
  
  
  RESULTS
  Of the 12 children, 10 had progressive familial intrahepatic cholestasis (PFIC) and 2 had Alagille syndrome (AS). PIBD was done using an isolated jejunal loop as a conduit from gall bladder to mid ascending colon. Median period of follow up was 30 months. Pruritus resolved in nine children with significant reduction of serum bile acids (P < 0.02).
  
  
  CONCLUSIONS
  To our knowledge, this is the largest reported series of children with PIBD. PIBD is a safe, well-tolerated and effective alternative to liver transplant in children with PFIC and AS who have intractable pruritus in the absence of synthetic liver failure.
authors: Kanchi Kamakoti Childs Trust Hospital and Childs Trust Medical Research Foundation, Chennai, India, kidsurg@hotmail.com.
authors: P
authors: P
authors: Ramachandran
authors: N P
authors: NP
authors: Shanmugam
authors: S Al
authors: SA
authors: Sinani
authors: V
authors: V
authors: Shanmugam
authors: S
authors: S
authors: Srinivas
authors: M
authors: M
authors: Sathiyasekaran
authors: V
authors: V
authors: Tamilvanan
authors: M
authors: M
authors: Rela
mesh_terms: D001652:Bile Ducts / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D002779:Cholestasis / Q000150:complications* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011537:Pruritus / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome