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Risk factors analysis for clinical symptoms of prenatally diagnosed choledochal cysts: a retrospective study
Dan Yang1, Long Li2,3, Mei Diao1
1Department of Pediatric Surgery, Children's Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment, Chinese Academy of Medical Sciences 2021RU015, 100020, Beijing, China.
Insights
Prenatal diagnosis timing and early GGT levels are key factors influencing clinical symptoms in choledochal cysts (CDCs). Early detection aids in predicting symptom onset and surgical timing for these congenital biliary anomalies.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Diagnostics
Background:
- Choledochal cysts (CDCs) are congenital biliary tract malformations requiring timely intervention.
- Identifying factors predicting clinical symptom development in prenatally diagnosed CDCs is crucial for management.
- Early symptom detection guides surgical planning and improves patient outcomes.
Purpose of the Study:
- To identify key factors influencing the development of clinical symptoms in prenatally diagnosed choledochal cysts (CDCs).
- To establish predictive markers for symptom onset and inform surgical timing.
- To improve the clinical management of infants with CDCs.
Main Methods:
- Retrospective review of medical records for 218 patients with prenatally diagnosed CDCs.
- Prenatal diagnosis confirmed via ultrasonography identifying fetal cysts.
- Univariate and multivariate logistic regression analyses were employed to identify symptom-associated factors.
Main Results:
- 61.5% of patients (134/218) exhibited clinical symptoms preoperatively.
- Earlier prenatal diagnosis, elevated Gamma-Glutamyl Transferase (GGT), Total Bilirubin (TBIL), and Direct Bilirubin (DBIL) were associated with symptoms.
- Multivariate analysis identified prenatal diagnosis timing (OR=0.898) and early GGT levels (OR=1.002) as independent predictors of clinical symptoms.
Conclusions:
- Approximately two-thirds of infants with prenatally diagnosed CDCs develop clinical symptoms before surgery.
- The timing of prenatal diagnosis and Gamma-Glutamyl Transferase (GGT) levels within the first week of life are significant independent predictors of symptom occurrence.
- These findings aid in risk stratification and optimizing surgical intervention for prenatally detected choledochal cysts.
Background:
This study aimed to screen the impact factors for clinical symptoms of prenatally diagnosed choledochal cysts (CDCs), to warn about the occurrence of clinical symptoms and the timing of surgery.
Methods:
Medical records of patients with prenatally diagnosed CDCs admitted to our hospital from April 2013 to April 2018 were retrospectively reviewed. Fetal hilar or abdominal cysts were found by prenatal ultrasonogram. All patients underwent laparoscopic cyst excision and hepaticojejunostomy in our center. Univariate analysis and multivariate logistic regression analysis were performed to screen the factors related to clinical symptoms intimately.
Results:
Two hundred eighteen cases were included. One hundred thirty-four patients (134/218, 61.5%) presented clinical symptoms before surgery. The results of univariate analysis showed that patients with clinical symptoms had earlier time of prenatal diagnosis (P = 0.002), higher values of GGT, TBIL, DBIL (P < 0.001, P < 0.001, P < 0.001, respectively) and larger maximum diameter of cyst before surgery (P = 0.012). Multivariate logistic regression analysis suggested that the time of prenatal diagnosis (P = 0.001, OR = 0.898, 95% CI: 0.845 ~ 0.955) and the GGT value within one week of life (P = 0.028, OR = 1.002, 95% CI: 1.000 ~ 1.003) were independent influencing factors for symptoms.
Conclusions:
For children with prenatally diagnosed CDCs, approximately 2/3 patients presented noticeable clinical symptoms before surgery. The time of prenatal diagnosis and the GGT value within 1 week of life were independent impact factors for the occurrence of clinical symptoms.
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