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Biliary amylase and congenital choledochal dilatation
M Davenport1, M D Stringer, E R Howard
1Department of Paediatric, Hepatobiliary Surgery, King's College Hospital, London, England.
Journal of Pediatric Surgery
|March 1, 1995
Summary
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.