title: Stool color card screening for early detection of biliary atresia and long-term native liver survival: a 19-year cohort study in Japan.
abstract: OBJECTIVE
  To evaluate the sensitivity and specificity of a stool color card used for a mass screening of biliary atresia conducted over 19 years. In addition, the age at Kasai procedure and the long-term probabilities of native liver survival were investigated.
  
  
  METHODS
  From 1994 to 2011, the stool color card was distributed to all pregnant women in Tochigi Prefecture, Japan. Before or during the postnatal 1-month health checkup, the mothers returned the completed stool color card to the attending pediatrician or obstetrician. All suspected cases of biliary atresia were referred for further examination. Diagnosis was confirmed by laparotomy or operative cholangiography for high-risk cases before the Kasai procedure. Patients with biliary atresia were followed from the date of their Kasai procedure until liver transplantation, death, or October 31, 2013, whichever comes sooner.
  
  
  RESULTS
  A total of 313,230 live born infants were screened; 34 patients with biliary atresia were diagnosed. The sensitivity and specificity of stool color card screening at the 1-month check-up was 76.5% (95% CI 62.2-90.7) and 99.9% (95% CI 99.9-100.0), respectively. Mean age at the time of Kasai procedure was 59.7 days. According to Kaplan-Meier analysis, the native liver survival probability at 5, 10, and 15 years was 87.6%, 76.9%, and 48.5%, respectively.
  
  
  CONCLUSIONS
  The sensitivity and specificity of the stool color card have been demonstrated by our 19-year cohort study. We found that the timing of Kasai procedure and long-term native liver survival probabilities were improved, suggesting the beneficial effect of stool color card screening.
authors: Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan; Graduate School of Public Health, Teikyo University, Tokyo, Japan.
authors: Yan-Hong
authors: YH
authors: Gu
authors: Department of Pediatrics, Jichi Medical University, Tochigi, Japan.
authors: Koji
authors: K
authors: Yokoyama
authors: Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
authors: Koichi
authors: K
authors: Mizuta
authors: Department of Surgery, Dokkyo Medical University, Tochigi, Japan.
authors: Takashi
authors: T
authors: Tsuchioka
authors: Department of Hepatology, National Medical Center for Children and Mothers, National Center for Child Health and Development, Tokyo, Japan.
authors: Toyoichiro
authors: T
authors: Kudo
authors: Department of Pediatric Surgery, Tohoku University School of Medicine, Miyagi, Japan.
authors: Hideyuki
authors: H
authors: Sasaki
authors: Department of Pediatric Surgery, Tohoku University School of Medicine, Miyagi, Japan.
authors: Masaki
authors: M
authors: Nio
authors: Department of Education for Clinical Research, National Center for Child Health and Development, Tokyo, Japan.
authors: Julian
authors: J
authors: Tang
authors: Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
authors: Takayoshi
authors: T
authors: Ohkubo
authors: Department of Hepatology, National Medical Center for Children and Mothers, National Center for Child Health and Development, Tokyo, Japan.
authors: Akira
authors: A
authors: Matsui
mesh_terms: D001656:Biliary Atresia / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D042241:Early Diagnosis; D005243:Feces / Q000737:chemistry*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008403:Mass Screening / Q000379:methods*; D011171:Portoenterostomy, Hepatic / Q000379:methods; D011237:Predictive Value of Tests; D011247:Pregnancy; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends