Abstract | BACKGROUND: AIMS: This communication describes our experience with the use of cholagogues following surgery in EHBA and attempts to correlate the outcomes with the diameter of the ductules. MATERIAL AND METHODS: Fifty five EHBA patients treated by the Kasai procedure form the basis of this study; 35 patients treated during 1979-1986 and administered DHC (3-5 mg/kg) postoperatively and 20 patients treated during 1999-2002 and administered UDCA (15 mg/kg) postoperatively. The diameter of ductules was measured using an optical micrometer on 5 microm serial sections; the ducts were classified as type I (no demonstrable ducts, n = 14), type II (< 50 microm, n=22) and type III (> 50 microm, n = 19). The clinical outcome was categorized as 1 ( jaundice free survival at 5 years follow-up, n = 7), 2 (initial good response but deteriorated after one year, n = 27) and 3 (expired within one year following surgery, n = 21). The response to surgery was monitored using biochemical liver function tests (LFT), hepatobiliary scintigraphy ( HIDA scan) and occurrence of cholangitis. RESULTS: Age did not affect the size of ducts in both DHC and UDCA groups but patients in the DHC group were older than those treated with UDCA (mean age DHC: 105.22 +/- 33.53 days, UDCA: 74.68 +/- 23.73 days; p = 0.009). There was no statistically significant difference between duct size and postoperative LFT in both groups (DHC p = 0.1, UDCA p = 0.5). Bile excretion on HIDA scan was significantly better with larger ducts (DHC p = 0.003, UDCA p = 0.025); overall UDCA showed significantly better bile excretion (p = 0.003) but this was not reflected in the surgical outcome. There was no significant difference in the surgical outcome of those treated with DHC or UDCA but a significantly higher incidence of cholangitis was seen with smaller ducts in the UDCA group (p = 0.02). CONCLUSIONS: There was no correlation between duct diameter and postoperative LFT but type III ducts were associated with better bile flow on HIDA scan. Cholangitis was seen more often with type I and II ducts in both DHC and UDCA groups. UDCA administration seemed to be beneficial in patients with type III ducts in increasing bile flow and reducing cholangitis.
|
Authors | M K Mohanty, S Datta Gupta, V Bhatnagar |
Journal | Tropical gastroenterology : official journal of the Digestive Diseases Foundation
(Trop Gastroenterol)
2010 Jul-Sep
Vol. 31
Issue 3
Pg. 184-9
ISSN: 0250-636X [Print] India |
PMID | 21560523
(Publication Type: Journal Article)
|
Chemical References |
- Ursodeoxycholic Acid
- Dehydrocholic Acid
|
Topics |
- Bile
(drug effects)
- Bile Ducts, Extrahepatic
(pathology, surgery)
- Bile Ducts, Intrahepatic
(pathology, surgery)
- Biliary Atresia
(pathology, surgery)
- Combined Modality Therapy
- Dehydrocholic Acid
(therapeutic use)
- Female
- Humans
- Infant
- Liver Function Tests
- Male
- Organ Size
- Portoenterostomy, Hepatic
- Treatment Outcome
- Ursodeoxycholic Acid
(therapeutic use)
|