Biliary amylase and congenital choledochal dilatation
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M Davenport1, M D Stringer, E R Howard
1Department of Paediatric, Hepatobiliary Surgery, King's College Hospital, London, England.
Insights
Children with choledochal cysts presenting with pancreatitis have higher biliary amylase levels than those with painless jaundice. Antenatal diagnosis suggests a congenital cause for some choledochal cysts.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Congenital Abnormalities
Background:
- Congenital biliary dilatation, or choledochal cyst, is a rare condition.
- Clinical presentation and biochemical markers can vary significantly.
Purpose of the Study:
- To investigate the relationship between biliary amylase levels and clinical features in children with choledochal cysts.
- To differentiate between types of choledochal dilatation and their presentation.
Main Methods:
- Retrospective analysis of 55 children with choledochal cysts treated between 1976 and 1993.
- Measurement of biliary amylase levels during surgery.
- Correlation of amylase levels with clinical presentation, age, and cyst type (cystic vs. fusiform).
Main Results:
- Pancreatitis presentation was associated with older age and 100% incidence of raised biliary amylase, compared to 44% in painless jaundice.
- No significant differences in age, presentation, or amylase levels were found between cystic and fusiform dilatations.
- A positive correlation between age at surgery and biliary amylase was observed in cystic dilatations.
Conclusions:
- Children presenting later with pancreatitis and choledochal cysts invariably have high biliary amylase, likely due to a common channel.
- Antenatally diagnosed choledochal cysts showed no significant amylase reflux, supporting a congenital etiology for this subgroup.
Abstract:
The relationship between levels of biliary amylase measured at operation and clinical features was studied in a series of 55 children with congenital biliary dilatation (choledochal cyst) who presented between 1976 and 1993. There were 36 cystic and 19 fusiforms dilatations in the series. The most common modes of presentation were painless jaundice (n = 23) and pancreatitis (n = 22). Five infants presented with abnormal antenatal ultrasound examinations. Children with pancreatitis were older than those with painless jaundice (4.2 versus 1.5 years; P = .005), and a higher proportion had raised levels of biliary amylase (100% versus 44%; P < .0001). There was no difference in the age at presentation (P = .32), clinical mode of presentation (P = .3), or the level of biliary amylase (P = .25) between cystic and fusiform dilatations. A correlation was found between age at surgery and biliary amylase in the cystic (rs = 0.55; P = .001) but not in the fusiform group (P = .22). All infants with antenatal diagnoses were cystic dilatations. Choledochal cystic dilatations that were diagnosed antenatally did not have significant amylase reflux, suggesting that the aetiology of this subgroup is truly congenital. Children who present at a later age with pancreatitis invariably have high levels of biliary amylase, which is presumed to occur because of a common channel and reflux of biliary and pancreatic secretions.