Effects of the infant stool color card screening program on 5-year outcome of biliary atresia in taiwan
✍ Scribed by Tien-Hau Lien; Mei-Hwei Chang; Jia-Feng Wu; Huey-Ling Chen; Hung-Chang Lee; An-Chyi Chen; Mao-Meng Tiao; Tzee-Chung Wu; Yao-Jong Yang; Chieh-Chung Lin; Ming-Wei Lai; Hong-Yuan Hsu; Yen-Hsuan Ni; the Taiwan Infant Stool Color Card Study Group
- Publisher
- John Wiley and Sons
- Year
- 2010
- Tongue
- English
- Weight
- 135 KB
- Volume
- 53
- Category
- Article
- ISSN
- 0270-9139
No coin nor oath required. For personal study only.
✦ Synopsis
Yen-Hsuan Ni, 1 and the Taiwan Infant Stool Color Card Study Group*
In Taiwan, a screening system using an infant stool color card to promote the early diagnosis of biliary atresia (BA) was established in 2002. This study aimed to investigate the 5-year outcome of BA before and after using the screening program. BA patients were divided into three cohorts according to their birth dates. The patients in cohort A (n 5 89) were born before the stool card screening program (1990-2000); those in cohort B (n 5 28) were screened by the stool card regional screening program (2002-2003); and those in cohort C (n 5 74) were screened by the stool card universal screening program (2004-2005). The relative odds ratios were computed using logistic regression to compare the different factors affecting survival time. The rate of age at Kasai operation <60 days was 49.4% and 65.7% in cohorts A and B1C, respectively (P 5 0.02). The jaundice-free (total serum bilirubin <2.0 mg/dL) rate 3 months after surgery was 34.8% and 60.8% in cohorts A and B1C, respectively (P < 0.001). The 3-year jaundice-free survival rate with native liver was 31.5% in cohort A and 56.9% in cohort B1C (P < 0.001), whereas the 3-year overall survival rates were 64.0% and 89.2%, respectively (P < 0.001). The 5-year jaundice-free survival rate with native liver was 27.3% in cohort A and 64.3% in cohort B (P < 0.001), and the 5-year overall survival rates were 55.7% and 89.3%, respectively (P < 0.001). Conclusion: The stool color card screening program for BA allows for earlier Kasai operation, which increases the jaundice-free rate at 3 months postsurgery. With higher surgical success rates, the 3-and 5-year outcome of BA patients in Taiwan improves remarkably. (HEPATOLOGY 2011;53:202-208) B iliary atresia (BA) is an inflammatory, progressive fibro-sclerosing cholangiopathy of infancy that variably affects both the extrahepatic and intrahepatic bile ducts, 1,2 resulting in the destruction and obstruction of the biliary tract. If untreated, BA progresses to cirrhosis with portal hypertension and liver failure leading to death within 2 to 3 years. Since the Kasai operation was first used for BA in 1959, there have been encouraging results in treating this dis-ease such that it has become the first-line treatment. The Kasai operation can restore bile flow through a reconstructed hepatic portoenterostomy to a jejunal loop. Once the cholestasis progresses and/or complications of liver cirrhosis occur, liver transplantation remains the salvage way for BA. Although ongoing cholestasis, which further aggravates liver cirrhosis, is present in most BA children, 5 a successful Kasai operation may still delay or even decrease the need for liver transplantation.