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Updated: Apr 25, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Grade IV fibrosis interferes in biliary drainage after Kasai procedure
A A Salzedas-Netto1, E Chinen1, D F de Oliveira1
1Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
Insights
Late diagnosis of biliary atresia (BA) negatively impacts prognosis. Hepatic portoenterostomy (HPE) success, indicated by biliary drainage, is linked to earlier surgery and less severe liver fibrosis.
Area of Science:
- Pediatric Surgery
- Hepatology
- Gastroenterology
Background:
- Biliary atresia (BA) is a leading cause of pediatric liver transplantation.
- Early diagnosis and treatment are crucial for improved outcomes in BA patients.
Purpose of the Study:
- To assess the impact of delayed diagnosis on children with BA.
- To evaluate histopathological findings and the success rate of biliary drainage after hepatic portoenterostomy (HPE).
Main Methods:
- Retrospective analysis of 63 BA cases (1998-2011) at UNIFESP.
- Evaluation of clinical and pathological data for 42 patients who underwent HPE.
- Correlation of HPE timing, biliary drainage success, and histological fibrosis grading.
Main Results:
- HPE performed at a mean age of 86.5 days; only 16.6% operated by 60 days.
- Successful biliary drainage achieved in 31% of HPE surgeries.
- No successful drainage in patients with Grade IV fibrosis; higher fibrosis rates in non-draining cases operated after 60 days.
Conclusions:
- Earlier HPE correlates with better BA prognosis.
- Histological Grade IV fibrosis is associated with failed biliary drainage.
- Timely surgical intervention is critical for optimizing outcomes in biliary atresia.
Objectives:
Biliary atresia (BA) is the most common cause of liver transplantation in children. The earlier the treatment is done, the better the prognosis. The aim is to evaluate the impact of late diagnosis in children with BA, including the histopathological findings and success rate of biliary drainage in patients submitted to hepatic portoenterostomy (HPE).
Materials And Methods:
A retrospective study of cases of BA in the Department of Pediatric Surgery, Federal University of São Paulo (UNIFESP) between 1998-2011. We found 63 cases of BA; of these, 42 underwent HPE and 21 were referred for liver transplantation. Clinic and pathologic data were evaluated.
Results:
The HPE was performed with a mean age of 86.5 days, with 16.6% having the operation at 60 days or earlier; 59.2% between 61 and 90 days; and 23.8% after 90 days. Successful biliary drainage occurred in 31% of surgeries, Mean days when HPE drained was 69.1 days, and 94.3 days when the surgery did not drain (P = .05). All patients who were successfully drained, did not have grade IV fibrosis on histology. In cases in which surgery was performed after 60 days that had not drained, 25% had grade IV fibrosis on biopsy (P = .0469).
Conclusion:
The age of HPE relates to better prognosis of the disease. It was found that the rate of grade IV fibrosis is higher in no drainage patients. All patients with grade IV fibrosis had no biliary drainage.
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