The duodenal tube test is more specific than hepatobiliary scintigraphy for identifying bile excretion in the differenti
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ORIGINAL ARTICLE
The duodenal tube test is more specific than hepatobiliary scintigraphy for identifying bile excretion in the differential diagnosis of biliary atresia Daiki Yoshii1 · Yukihiro Inomata1,2 · Hirotoshi Yamamoto1,3 · Tomoaki Irie1 · Masashi Kadohisa1 · Kenji Okumura1,3 · Kaori Isono1 · Masaki Honda1 · Shintaro Hayashida1,2 · Yuki Oya1,2 · Taizo Hibi1 Received: 1 January 2020 / Accepted: 17 March 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose Confirmation of bile excretion into the gastrointestinal tract is important to exclude biliary atresia (BA). We compared the duodenal tube test (DTT) with hepatobiliary scintigraphy (HS) for their efficiency in detecting bile secretion. Methods The subjects of this retrospective study were 47 infants who underwent both DTT and HS to diagnose or exclude BA between January 2000 and March 2018. Results BA was diagnosed in 32 of the 47 patients, and 7 of the remaining 15 non-BA patients underwent intraoperative cholangiography. Among the various DTT parameters, the total bile acid in duodenal fluid (DF-TBA)/serum (S) gammaglutamyl transferase (γGTP) ratio was found to be the most specific for BA, with sensitivity and specificity of 98.0–100%, respectively. One BA patient in whom cut off values were not met was a premature infant. The sensitivity and specificity of HS were 100–56.3%, respectively. The diagnostic accuracy of the DF-TBA/S-γGTP parameter was higher than that of HS (98.6% vs. 85.1%, respectively). Conclusions The DTT could be more a specific method than HS to detect bile excretion. Thus, the DTT should be incorporated into the multidisciplinary diagnostic approach for the differential diagnosis of BA to prevent unnecessary intraoperative cholangiography in patients who do not have BA. Keywords Biliary atresia · Diagnostic methods · Duodenal tube test · γGTP · Total bile acid
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00595-020-02010-w) contains supplementary material, which is available to authorized users. * Yukihiro Inomata [email protected]‑u.ac.jp 1
Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1‑1‑1 Honjo, Chuo‑ku, Kumamoto, Kumamoto 860‑8556, Japan
2
Department of Pediatric Surgery and Transplantation, Kumamoto Rosai Hospital, 1670 Takeharamachi, Yatsushiro, Kumamoto 866‑8533, Japan
3
Department of Pediatric Surgery, Kumamoto City Hospital, 4‑1‑60 Higashimachi, Higashi‑ku, Kumamoto, Kumamoto 862‑8505, Japan
Biliary atresia (BA) is a rare infantile disease characterized by bile-duct obliteration of unknown pathogenesis [1]. Kasai portoenterostomy (KP) is usually performed in early infanthood; however, subsequent liver transplantation is necessary if KP fails. The patient age at KP has a significant impact on the long-term native liver survival rate. According to a previous report, patients who underwent KP during the neonatal period had the best rates of jaundice clearance and lon
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