Comparison between cystic biliary atresia and choledochal cyst: a clinical controlled study

It is difficult to distinguish cystic biliary atresia (CBA) from choledochal cyst (CC) before intraoperative cholangiography in neonates or young infants because of the similar ultrasonographic patterns and clinical manifestations. This study is to investigate the difference of clinical parameters between CBA and CC.

96 patients with cyst at hepatic hilum whose ages were less than 120 days during the period from Jan'2013 to Nov'2015 were retrospectively studied, they were divided into CBA group and CC group by intraoperative cholangiography, there were 29 cases of CBA and 67 cases of CC. It was compared and analyzed on laboratory data, preoperative ultrasonographic features, intraoperative cholangiography and histopathological results between the two groups. Data were quoted as means ± standard deviation (SD) or median (range), Student's t test, non-parametric test and χ2 test were used as appropriate. P < 0.05 was considered as significant statistical difference.

CBA group and CC group were comparable for the operative age (51.76 ± 23.99 days vs. 50.03 ± 26.38 days, P = 0.76), weight (4.60 ± 0.75 kg vs. 4.44 ± 1.03 kg, P = 0.46) and sex proportion (M/F: 9/20 vs. 20/47, P = 0.91). there were significant differences (CBA vs. CC) in ALT [59(3-375) vs. 30 (6-247) IU/L, P < 0.001], AST [140(30-694) vs. 44(18-410) IU/L, P < 0.001], T-Bil [190 (107-326) vs.87(5-310) μmol/L, P < 0.001], D-Bil [85 (31-174) vs.14(1-122) μmol/L, P < 0.001] and TBA [112 (23-269) vs.9(1-337) μmol/L, P < 0.001]. There was insignificant statistical difference in GGT [332(112-2154) vs. 226(21-1810) IU/L, P = 0.099] between CBA group and CC group. The cyst size in CBA group was obviously smaller than CC group (the maximum longitudinal diameter: 2.52 ± 1.16 cm vs. 4.71 ± 2.23 cm, P < 0.001; the maximum transverse diameter: 1.64 ± 0.75 cm vs. 3.41 ± 1.79 cm, P < 0.001). Significant differences presented in preoperative ultrasonographic features and histopathological results between the two groups.

CBA should be suspected if ultrasonography indicates small cyst with characteristic manifestations of BA and elevated laboratory data. GGT was an insensitive indicator in distinguishing CBA from CC. Cholangiography should be done for the suspected CBA patients as soon as possible to confirm the diagnosis and have surgical intervention timely.