Abstract
Background and objectives: For infants with biliary atresia (BA), solid research is lacking regarding the effectiveness of prophylactic antibiotics for preventing ascending cholangitis post-Kasai portoenterostomy (KPE), and the effectiveness of primary endoscopic screening for varices. We conducted a retrospective study of patients treated in four tertiary centers in Israel during 2008-2018.
Methods: We collected clinical and laboratory data of 72 children, from their diagnosis with BA until liver transplantation (LT) or the study's end.
Results: The median age at KPE was 58.5 days. Twenty-three (32%) patients had a successful KPE. The incidence of ascending cholangitis was similar among patients with successful and failed KPE: 6/23 (26%) and 15/45 (33%), respectively. Among the 35 (49%) patients treated with primary antibiotic prophylaxis, compared to those not treated, cholangitis episodes occurred earlier (after a median 77 vs. 239 days, p=0.016). Of the 72 patients, 28% underwent upper endoscopy for varices screening at median age of 5.5 years; this revealed normal findings in 45%, grade I varices in 35%, and grade II varices in 20%. A total of 28 patients (39%) underwent LT during the study follow-up. Survival with native liver (SNL) was 54% at 5 years.
Conclusion: Primary antibiotic prophylaxis did not appear to reduce ascending cholangitis episodes in our cohort. Endoscopic screening showed predominantly findings that did not warrant intervention. Further research is needed to establish evidence-based practices for the effective management of infants with BA.