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Updated: Aug 16, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Encouraging results with a modified Sawaguchi hepatoportoenterostomy for biliary atresia
Insights
Early modified Sawaguchi hepatoportoenterostomy for biliary atresia significantly improves outcomes. Infants operated on before 10 weeks achieved long-term jaundice resolution, making it preferable to liver transplantation.
Area of Science:
- Pediatric Surgery
- Hepatology
- Gastroenterology
Background:
- Biliary atresia is a severe neonatal liver disease requiring surgical intervention.
- Early diagnosis and treatment are crucial for improving patient prognosis.
Purpose of the Study:
- To evaluate the long-term efficacy of a modified Sawaguchi hepatoportoenterostomy in infants with biliary atresia.
- To compare outcomes based on the timing of surgical intervention.
Main Methods:
- A retrospective analysis of 25 patients with biliary atresia who underwent a modified Sawaguchi hepatoportoenterostomy since 1974.
- Patients were categorized based on surgical timing: before or after 10 weeks of age.
Main Results:
- 17 of 18 patients (94%) operated on before 10 weeks remained jaundice-free at 1-13 years follow-up.
- Two patients in this group required reoperation for bile flow issues but achieved resolution.
- In contrast, only 2 of 7 patients operated on after 10 weeks had initial bile drainage, with poor long-term outcomes.
Conclusions:
- The modified Sawaguchi hepatoportoenterostomy is a highly effective primary treatment for biliary atresia, particularly when performed before 10 weeks of age.
- Early surgical intervention significantly reduces the risk of jaundice recurrence and improves long-term survival compared to later operations.
Abstract:
Since 1974, 25 patients with biliary atresia underwent a modified Sawaguchi hepatoportoenterostomy. Seventeen of 18 patients operated on before the age of 10 weeks became free of jaundice within 2 to 4 months and had biliary intestinal continuity established by 10 months of age. Two of these patients experienced sudden diminution of bile flow with return of jaundice. Both responded to transconduit repeat resection of the portal fibrous tissue with resolution of jaundice, which allowed take-down of the biliostomy. At last follow-up 1 to 13 years postoperatively, all 17 patients were free of jaundice (94 percent of total). One patient in this group never had drainage of bile and eventually died from sepsis. In contrast, five of seven patients operated on after 10 weeks never had drainage of bile. Four of these patients died from hepatic failure and one from bleeding varices. Two patients initially had bile drainage and became anicteric, but thereafter, acute cessation of bile flow and reccurrence of jaundice occurred. Reoperation resulted in a definitive increase in bile flow in both of these patients. The modified Sawaguchi procedure is definitely preferable to liver transplantation as primary treatment in infants with biliary atresia, especially if operation is performed before the age of 10 weeks.
