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Pediatric Radiology

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01-01-2012 | Original Article

HIDA, percutaneous transhepatic cholecysto-cholangiography and liver biopsy in infants with persistent jaundice: can a combination of PTCC and liver biopsy reduce unnecessary laparotomy?

Authors: M. Kyle Jensen, Vincent F. Biank, David C. Moe, Pippa M. Simpson, Shun Hwa Li, Grzegorz W. Telega

Published in: Pediatric Radiology | Issue 1/2012

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.

Materials and 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).

Conclusion

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.

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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?
Authors: M. Kyle Jensen
Vincent F. Biank
David C. Moe
Pippa M. Simpson
Shun Hwa Li
Grzegorz W. Telega
Publication date: 01-01-2012
Publisher: Springer-Verlag
Published in: Pediatric Radiology / Issue 1/2012
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-011-2202-4

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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

Objective

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Materials and methods

Results

Conclusion

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