Use of percutaneous cholecysto-cholangiogram in the evaluation of neonatal cholestasis

The gold standard for diagnosing biliary atresia (BA) is intraoperative cholangiography (IOC) demonstrating patency of the biliary system. Given the invasive nature of this procedure, clinicians rely on less invasive tests to minimize unnecessary laparotomies. We aimed to describe our single-center experience using percutaneous cholecysto-cholangiography (PCC) in the evaluation of neonatal cholestasis.

This retrospective study included infants aged 0-6 months with neonatal cholestasis referred for PCC at a children's hospital from 2015 to 2022. Demographics and clinical information were compared across three groups: infants with normal PCC, infants with abnormal PCC, and those in whom PCC was attempted but the gallbladder was not identified.

Twenty-four patients were evaluated (mean age at presentation 44 days (standard deviation [SD] 31.24), median birth weight 3.07 kg (interquartile range [IQR] 2.54-3.37), male 12 (50%). PCC findings were normal in 8 (33.3%), abnormal in 10 (41.7%), and not performed in 6 (25%) due to a non-visualized gallbladder. PCC was feasible in patients with contracted or diminutive gallbladder on ultrasound. BA was confirmed intraoperatively in all the patients with abnormal PCCs and a non-visualized gallbladder. The average fluoroscopy time was 2.02 min (SD 0.88), and the average fluoroscopy dose was 4.58 mGy (SD 3.24). No post-procedure complications were reported. Histology was discordant with PCC in four patients; final diagnosis supported the PCC findings.

PCC is a safe procedure and can be performed concurrently with liver biopsy. It serves as a valuable adjunct in the diagnostic workup of neonatal cholestasis when BA is suspected.