The evolution of early liver biopsy findings in babies with jaundice may delay the diagnosis and treatment of biliary atresia

Caroline Lemoine, Hector Melin-Aldana, Katherine Brandt, Saeed Mohammad, Riccardo Superina*

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Background: The early diagnosis of biliary atresia (BA) is associated with a better outcome after portoenterostomy. However, very early liver biopsy findings may appear atypical for BA and delay diagnosis. Repeat biopsy histology may change rapidly to show more typical features. Methods: Between 1997 and 2018, 6 babies with jaundice had more than one biopsy to establish diagnosis. Clinical and histologic data were collected. chi-Square was used for analysis (p < 0.05 significant). Results: Five patients had two biopsies, and one had three. Median age at first, second, and third biopsy was 40 (13–57), 68.5 (35–78), and 133 days, respectively. Biopsy readings showed no portal edema initially (0/6), but in all 6 on repeat biopsy (p = 0.001). Bile duct proliferation was seen in 6/6 final biopsies, but in only 1/6 initially (p = 0.003). All patients underwent a portoenterostomy (median age 75 days (43–113)). Median delay between initial biopsy and Kasai was 29 days (14–67). Transplant free survival (n = 5 patients) ranged from 184 to 716 days (median 309 days). One patient died before being transplanted. Conclusion: Early biopsies may not display characteristic findings of BA, but these can appear quickly on subsequent evaluation. The interval needed to repeat a biopsy may have an adverse effect on bile drainage. Level of Evidence: IV

Original languageEnglish (US)
Pages (from-to)866-872
Number of pages7
JournalJournal of pediatric surgery
Volume55
Issue number5
DOIs
StatePublished - May 2020

Keywords

  • Biliary atresia
  • Histology findings
  • Liver biopsy

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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