Biliary atresia vs. non-biliary atresia: An assessment of the ultrasonography and scintigraphy findings with liver biopsy

Introduction: Children with biliary atresia referred for surgery before 60 days of age do dramatically better than those older than 90 days at the time of operation in regard to re-establishment of bile flow which is more than 80% versus less than 20% respectively. There are a lot of investigations available for diagnosing BA but it takes more time to conclude the diagnosis. Ultimately there is delay in surgery which increases the mortality of the patient. Aim of the study: To assess the ultrasonographic and scintigraphic findings with liver biopsy and evaluate the comparison between biliary atresia and non-biliary atresia.Materials and Methods: A cross-sectional study was conducted in Department of Pediatric Gastroenterology, Hematology & Nutrition, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh from March 2018 to August 2019. Results were expressed as mean ± standard deviation (SD) or number or percentage as appropriate and were presented in the form of table and diagram. Ultrasonography & Hepatobiliary scintigraphy findings were analyzed. The accuracy of the abdominal ultrasonography and hepatobiliary scintigraphy was evaluated for diagnosis of BA and differentiation from non-BA cases. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of ultrasonography and hepatobiliary scintigraphy was calculated with liver biopsy as gold standard. Statistical analyses were carried out using the SPSS statistical package, version 23 (SPSS Inc., Chicago, IL, USA) for Windows XP. Data were expressed as numbers and percentages for qualitative variables or as mean± SD and median range (minimum and maximum) for quantitative variables. Results: Ultrasonography & scintigraphic findings with liver biopsy was assessed in this study. On comparing the ultrasonographic findings between biliary atresia and non-BA, the frequency of a non-contractile gallbladder was significantly higher in BA than that in non-BA infants. Contracted gallbladder was found in 13 (61.9%) cases with BA and 8 (27.5%) in non-BA cases and difference is significant (p 0.001). No pre and postprandial change of size of gallbladder were 17 (81%) in BA vs 10 (34.5%) in non BA cases. The difference was statistically significant (p 0.001). An ultrasonographic diagnosis of BA was made in 27 (54.0%) infants and that of non-BA in 23 (46%) infants. Scintigraphy was significantly negative (n=19, 90.5%) among BA than non BA (n=16, 55.2%) subjects (p 0.001). An scintigraphic diagnosis of BA was made in 35 (70.0%) infants and that of non-BA in 15 (30.0%) infants. Diagnostic accuracy of USG and hepatobiliary scintigraphy for diagnosis of BA was 72.0% and 64.0% respectively.Conclusion: Ultrasonography & hepatobiliary scintigraphy are two important investigations for diagnosing biliary atresia Numerous ultrasonographic & hepatobiliary scintigraphy findings have been described as useful pointers for the diagnosis of BA in this study. Diagnostic accuracy of ultrasonography is more than hepatobiliary scintigraphy for diagnosing biliary atresia.