Duodenal intubation and test for bile: a reliable method to rule out biliary atresia

• Published in: Pediatric surgery international Vol. 18; no. 5-6; pp. 392 - 395
• Main Authors: MEISHERI, I. V, KASAT, L. S, KUMAR, Anil, BAHETY, G, SAWANT, V, KOTHARI, P
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Heidelberg Springer 01.09.2002; Berlin Springer Nature B.V
• Subjects: Bile - chemistry; Biliary Atresia - diagnosis; Biological and medical sciences; Body Fluids - chemistry; Female; Functional investigation of the digestive system; Humans; Imino Acids; Infant; Intubation, Gastrointestinal; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Radionuclide study; Biliary tract; Liver; Infant; Scintigraphy; Biliary tract disease; Duodenal intubation; Atresia; Diagnosis; HIDA scan; Human; Biliary atresia; Radiodiagnosis; Cholangiography; Duodenum; Congenital disease; Pathology; Newborn; Neonatal jaundice; Malformation; Biopsy; Non invasive method; Draft tube; Digestive diseases; Medical imagery; Computerized axial tomography; Peroperative cholangiography
• ISSN: 0179-0358; 1437-9813
• DOI: 10.1007/s00383-002-0767-6

Between January 1997 and December 1998, 30 consecutive children with suspected biliary atresia (BA) were selected to assess whether duodenal intubation (DI) and testing of aspirate for bile would help to rule out BA. Duodenal fluid was aspirated every 2 h for 24 h and tested for bile. A HIDA scan was also done in all cases. Every patient underwent a peroperative cholangiogram (POC) and liver biopsy; a Kasai portoenterostomy was done in indicated cases. In 22 cases all three investigations (DI, HIDA scan, POC) suggested BA. In 3 the HIDA scan ruled out BA, but DI and POC suggested BA. In 2 other cases, both the HIDA scan and DI suggested BA, but POC ruled it out and suggested biliary hypoplasia; in 3 others the HIDA scan suggested BA, but DI and POC both, ruled it out. There was no case where DI ruled out BA (i.e., showed bile in aspirate) and POC suggested BA. A liver biopsy confirmed BA in all proven cases. DI and testing the aspirate for bile is a very reliable means to rule out BA if the aspirate tests positive. It is an inexpensive, noninvasive, and quick bedside test that may be especially useful in developing countries where biliary scintigraphy is not available.