Cholangitis Definition and Treatment after Kasai Hepatoportoenterostomy for Biliary Atresia: A Delphi Process and...

Area of Science:

• Pediatric Surgery
• Hepatology
• Infectious Disease

Background:

• Acute cholangitis post-Kasai hepatoportoenterostomy (HPE) significantly impacts patient and native liver survival.
• Lack of standardized guidelines for cholangitis definition, treatment, and prophylaxis after HPE hinders effective management.
• The study addresses the critical need for consistent protocols in the first year following HPE.

Purpose of the Study:

• To establish evidence-based guidelines for the definition, treatment, and prophylaxis of acute cholangitis within the first year after Kasai hepatoportoenterostomy (HPE).
• To enable standardized reporting and facilitate prompt clinical management of cholangitis in this vulnerable patient population.

Main Methods:

• Utilized the Delphi method, incorporating an extensive literature review.
• Conducted iterative rounds of surveys and expert panel discussions among international specialists.
• Focused on establishing consensus for cholangitis definition, treatment duration, and prophylactic strategies post-HPE.

Main Results:

• Identified eight key elements (clinical and laboratory/imaging) for defining cholangitis after HPE.
• Proposed definitions for suspected (one element from each group) and confirmed cholangitis (two elements from each group plus positive blood culture).
• Achieved uniform expert agreement on treatment and prophylaxis durations for both suspected and confirmed cholangitis.

Conclusions:

• An international consensus on guidelines for defining, treating, and preventing cholangitis in the first year post-Kasai HPE has been established.
• These guidelines provide a standardized approach to managing cholangitis after HPE.
• Further validation through prospective, multicentered studies is recommended to confirm the applicability of these guidelines.