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Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Screening for biliary atresia
1Graduate School of Nursing Science, St. Luke's International University, 3-8-5 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. matsui-a@ncchd.go.jp.
Insights
Early diagnosis of biliary atresia (BA) through screening is crucial. Both home-based stool color chart (SCC) and laboratory-based (DB/CB) methods show potential but require further study for feasibility and cost-effectiveness.
Area of Science:
- Pediatrics
- Hepatology
- Public Health
Background:
- Biliary atresia (BA) requires early diagnosis and Kasai procedure (KP) for improved long-term prognosis.
- KP before 30 days of age significantly enhances native liver survival rates.
Purpose of the Study:
- To evaluate the feasibility and cost-effectiveness of different screening methods for biliary atresia (BA).
- To compare home-based stool color chart (SCC) screening with laboratory-based (DB/CB) screening for BA.
Main Methods:
- Review of published analyses on SCC and DB/CB screening for BA.
- Analysis of implemented screening programs in Japan and Taiwan.
- Consideration of home-based (SCC) and laboratory-based (DB/CB) screening approaches.
Main Results:
- Screening with SCC has been implemented in Japan since 1994 and Taiwan since 2004.
- Home-based SCC is easy and cost-effective but can pose challenges with intermediate stool colors.
- Laboratory-based DB/CB may increase early KP but has a recall rate of 1%.
Conclusions:
- Further research is necessary to determine the optimal screening strategy for BA.
- Assessing the feasibility and cost-effectiveness of both SCC and DB/CB screening is essential.
Abstract:
Early diagnosis followed by proper KP is essential for the improvement of long-term prognosis for patients with BA. It is increasingly accepted that KP at ≤ 30 days of age significantly improves native liver survival rate. Published analyses in English and Japanese indicate that screening by SCC and DB/CB is potentially feasible. Screening with SCC has been implemented in Tochigi Prefecture, Japan, since 1994. The concept of SCC was introduced from Japan to Taiwan and resulted in nationwide screening with SCC for the first time in Taiwan in 2004, followed by Japan in 2012. Home-based screening using SCC is easy and cost-effective; however, it may cause some difficulties for families in case of stools with intermediate colors. Laboratory-based screening using DB/CB may detect the suspected cases earlier, resulting in an increase in the number of patients with BA who undergo KP at ≤ 30 days of age; however, the recall rate is 1% and may be beyond an acceptable range. Further studies are needed to assess the feasibility and cost-effectiveness of both home-based (SCC) and laboratory-based (DB/CB) screening for BA.
