Relevance of Diagnostic and Therapeutic Aspects in the Prognosis of Biliary Atresia
An Integrative Review
DOI:
https://doi.org/10.36557/2674-8169.2024v6n9p3533-3542Keywords:
Cholestasis, Biliary atresia, PrognosisAbstract
INTRODUCTION: Biliary atresia (AVB) is a neonatal-exclusive condition characterized by obstruction of the intra- and extrahepatic bile ducts. Despite its unknown etiology, BA is a major suspicion in neonates with persistent jaundice after 14 days of life, being a rare but severe condition. OBJECTIVE: To analyze the diagnostic and therapeutic aspects of biliary atresia and its influence on the prognosis of pediatric patients from January 2013 to January 2024. METHODOLOGY: This study is an integrative review conducted according to the PRISMA 2020 protocol criteria. Studies in English and Portuguese published within the specified period were included. Articles that were unavailable, duplicates, case reports, animal studies, and other methodologies were excluded. RESULTS: The initial search identified 821 articles, of which 113 were selected for full-text review, resulting in 20 articles included in the review. DISCUSSION: Laboratory and imaging tests proved effective for the early diagnosis of AVB, reducing the need for invasive biopsies, with matrix metalloproteinase-7 (MMP-7) emerging as a promising biomarker. Kasai portoenterostomy (PEK) remains the standard treatment; however, antibiotic therapy was crucial in combating recurrent cholangitis, while corticosteroid therapy showed no significant clinical benefits. The age at the time of the procedure, postoperative bile drainage, and improvement in test results are the best predictors of prognosis, with pre- and postoperative status influenced by factors such as malnutrition, associated pathologies, and surgical technique. CONCLUSION: The selected articles recognize AVB as a multifactorial disease with better outcomes when treated in a timely manner. Early diagnosis is achievable through a combination of clinical, laboratory, and imaging assessments. High-quality surgical treatment is associated with the individualization of tools and monitoring of complications. New studies are needed to evaluate and update treatment approaches.
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ALEXOPOULOS, S. P.; NEKRASOV, V.; CAO, S. et al. Effects of recipient size and allograft type on pediatric liver transplantation for biliary atresia. Liver Transpl, v. 23, n. 2, p. 221-233, 2017. DOI: 10.1002/lt.24675.
ALONSO, E. M.; YE, W.; HAWTHORNE, K. et al. Impact of Steroid Therapy on Early Growth in Infants with Biliary Atresia: The Multicenter Steroids in Biliary Atresia Randomized Trial. J Pediatr., v. 202, p. 179-185.e4, 2018. DOI: 10.1016/j.jpeds.2018.07.002.
ASAI, A.; MIETHKE, A.; BEZERRA, J. A. Pathogenesis of BA. Nat Rev Gastroenterol Hepatol, v. 12, p. 342-352, 2016.
BALISTRERI, W. F.; BEZERRA, J. A.; RYCKMAN, F. C. Biliary atresia and other disorders of the extrahepatic bile ducts. Liver Dis. Child. Fourth Edi, New York: Cambridge, p. 155-176, 2014.
BEZERRA, J. A.; SPINO, C.; MAGEE, J. C. et al. Use of corticosteroids after hepatoportoenterostomy for bile drainage in infants with biliary atresia: the START randomized clinical trial. JAMA, v. 311, n. 17, p. 1750-9, 2014. DOI: 10.1001/jama.2014.2623. PMID: 24794368; PMCID: PMC4303045.
CARVALHO, E. DE; SANTOS, J. L. DOS; SILVEIRA, T. R. DA et al. Atresia biliar: a experiência brasileira. J. Pediatr. (Rio J.), v. 86, n. 6, p. 473-479, 2010.
CHEN, X.; DONG, R.; SHEN, Z. et al. Value of Gamma-Glutamyl Transpeptidase for Diagnosis of Biliary Atresia by Correlation With Age. J Pediatr Gastroenterol Nutr, v. 63, n. 3, p. 370-373, 2016. DOI: 10.1097/MPG.0000000000001168.
CHUNG, P. H.; WONG, K. K.; TAM, P. K. Predictors for failure after Kasai operation. J Pediatr Surg, v. 50, n. 2, p. 293-296, 2015. DOI: 10.1016/j.jpedsurg.2014.11.015.
GODBOLE, N.; NYHOLM, I.; HUKKINEN, M. et al. Liver secretin receptor predicts portoenterostomy outcomes and liver injury in biliary atresia. Sci Rep, v. 12, n. 1, p. 7233, 2022. DOI: 10.1038/s41598-022-11140-9.
GUEDES, R. R.; KIELING, C. O.; DOS SANTOS, J. L. et al. Severity of Ascites Is Associated with Increased Mortality in Patients with Cirrhosis Secondary to Biliary Atresia. Dig Dis Sci, v. 65, n. 11, p. 3369-3377, 2020. DOI: 10.1007/s10620-019-06029-z.
IHN, K.; HO, I. G.; CHANG, E. Y.; HAN, S. J. Correlation between gamma-glutamyl transpeptidase activity and outcomes after Kasai portoenterostomy for biliary atresia. J Pediatr Surg, v. 53, n. 3, p. 461-467, 2018.
KASAHARA, M.; UMESHITA, K.; SAKAMOTO, S. et al. Living donor liver transplantation for biliary atresia: An analysis of 2085 cases in the registry of the Japanese Liver Transplantation Society. Am J Transplant, v. 18, n. 3, p. 659-668, 2018. DOI: 10.1111/ajt.14489.
KITAJIMA, T.; SAKAMOTO, S.; SASAKI, K. et al. Living donor liver transplantation for post-Kasai biliary atresia: Analysis of pretransplant predictors of outcomes in infants. Liver Transpl, v. 23, n. 9, p. 1199-1209, 2017. DOI: 10.1002/lt.24796.
LIU, X.; PENG, X.; HUANG, Y. et al. Design and validation of a noninvasive diagnostic criteria for biliary atresia in infants based on the STROBE compliant. Medicine (Baltimore), v. 98, n. 6, p. e13837, 2019. DOI: 10.1097/MD.0000000000013837.
NETO, J. S.; FEIER, F. H.; BIERRENBACH, A. L. et al. Impact of Kasai portoenterostomy on liver transplantation outcomes: A retrospective cohort study of 347 children with biliary atresia. Liver Transpl, v. 21, n. 7, p. 922-927, 2015. DOI: 10.1002/lt.24132.
NIO, M.; WADA, M.; SASAKI, H. et al. Technical standardization of Kasai portoenterostomy for biliary atresia. J Pediatr Surg, v. 51, n. 12, p. 2105-2108, 2016. DOI: 10.1016/j.jpedsurg.2016.09.047.
PAGE, M. J.; MCKENZIE, J. E.; BOSSUYT, P. M. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, v. 372, p. n71, 2021. DOI: 10.1136/bmj.n71
PAKARINEN, M. P.; RINTALA, R. J. Surgery of biliary atresia. Scand J Surg, v. 100, n. 1, p. 49-53, 2011.
SHNEIDER, B. L.; MAGEE, J. C.; KARPEN, S. J. et al. Total Serum Bilirubin within 3 Months of Hepatoportoenterostomy Predicts Short-Term Outcomes in Biliary Atresia. J Pediatr, v. 170, p. 211-217.e72, 2016. DOI: 10.1016/j.jpeds.2015.11.058.
SONG, Z.; DONG, R.; SHEN, Z. et al. Surgical outcome and etiologic heterogeneity of infants with biliary atresia who received Kasai operation less than 60 days after birth: A retrospective study. Medicine (Baltimore), v. 96, n. 26, e7267, 2017. DOI: 10.1097/MD.0000000000007267.
WANG, P.; ZHANG, H. Y.; YANG, J. et al. Severity assessment to guide empiric antibiotic therapy for cholangitis in children after Kasai portoenterostomy: a multicenter prospective randomized control trial in China. Int J Surg, v. 109, n. 12, p. 4009-4017, 2023. DOI: 10.1097/JS9.0000000000000682.
WITT, M.; VAN WESSEL, D. B. E.; DE KLEINE, R. H. J. et al. Prognosis of Biliary Atresia After 2-year Survival With Native Liver: A Nationwide Cohort Analysis. J Pediatr Gastroenterol Nutr, v. 67, n. 6, p. 689-694, 2018. DOI: 10.1097/MPG.0000000000002130.
YANG, L.; ZHOU, Y.; XU, P. P. et al. Diagnostic Accuracy of Serum Matrix Metalloproteinase-7 for Biliary Atresia. Hepatology, v. 68, n. 6, p. 2069-2077, 2018. DOI: 10.1002/hep.30234.
ZANI, A.; QUAGLIA, A.; HADŽIĆ, N. et al. Cytomegalovirus-associated biliary atresia: An aetiological and prognostic subgroup. J Pediatr Surg, v. 50, n. 10, p. 1739-1745, 2015. DOI: 10.1016/j.jpedsurg.2015.03.001.
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Copyright (c) 2024 Débora Cardoso de Oliveira, Amanda Campos de Godoi Amaro, Beatriz da Silva Ferreira de Lima, Camilla Melo Mendonça, Ingrid Silva Medeiros, João Pedro Oliveira da Silva, Lídia Souza Araujo, Maria Fernanda Dantas de Moraes, Miriam Santos Nunes, Natália Carvalho Fonseca, Taylane Caroline Cunha Carvalho, Ed Carlos Rey Moura, Plínio da Cunha Leal, Caio Márcio Barros de Oliveira
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