Researchers seek to improve the 'diagnostic odyssey' of infant biliary atresia evaluations
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Key takeaways
- A new ultrasound approach helped identify patients later diagnosed with biliary atresia.
- The method would provide a quicker, less invasive approach that would not require fasting.
SAN DIEGO — A new ultrasound approach may help more quickly and less invasively identify infants with biliary atresia, according to research presented at The Liver Meeting.
“An important problem in pediatric hepatology is improving the diagnostic odyssey that infants with cholestasis undergo to determine whether or not they have biliary atresia,” During the presentation, Ashley Upton, a pediatric sonographer at Texas Children's Hospital, “These babies often go through many lab tests, imaging that requires fasting, and liver biopsies and cholangiograms that require general anesthesia.”
Upton explained that she and her colleagues sought to improve the diagnostic process by identifying an ultrasound method that could help diagnose the condition in infants.
To do so, Upton and colleagues reviewed ultrasound exams from infants at Texas Children’s Hospital who were being assessed for biliary atresia. The researchers reviewed ultrasound exams prior to 2021 to develop a method visualize the duct at the hilum. They then reviewed exam from the subsequent 26 months to determine the diagnostic performance of the method.
The 4-step method included locating the pancreatic head, visualizing the duct lengthwise instead of in a cross-section, and feeding infants rather than fasting to allow the bile duct to appear more prominently.
The researchers assessed this approach on 64 infants, with a median weight of 3.2 kg and a median age of 25 days.
Upton and colleagues found that when practitioners implemented the method immediately after infants were fed, it identified all 12 infants who were later diagnosed with biliary atresia.
According to the researchers, the approach was complete in less than 5 minutes for 75.5% of infants without biliary atresia.
“At our hospital, we have now transformed our practice with the feeding ultrasound method. Now, the second test immediately after high conjugated bilirubin is found to quickly triage infants who may have biliary atresia,” Upton said during the presentation. “Our next steps are now to test our method more widely. In particular, we’re interested in assessing how the method works in different types of biliary atresia, including the rare type-1 case, which do have a common hepatic duct.”
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Upton A, et al. An Ultrasound Approach to Visualize the ‘Duct at the Hilum’ in Infants Undergoing Evaluation for Biliary Atresia. Presented at: The Liver Meeting; Nov. 15-19, 2024; San Diego (hybrid meeting).
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