| IntroductionBA (biliary atresia) means a whole or a part of the bile ducts is absolutely atretic and completely obstructs bile flow. The incidence of BA is about 1 in 12, 000 to 10,000 live births. It is reported that the prognosis of BA is mainly attributed to the patients'days of life when receiving the Kasai procedure. However , early diagnosis of BA from IHS ( infantile hepatitis syndrome) is very difficult due to the similar clinical presentations. Since 1990s, Bilitec 2000 has gained acceptance as a reliable ambulatory fibreoptic device to detect the bilirubin in gastroenteritic tract. The aim of this study was to identify BA from infantile cholestasis and evaluate the severity of biliary duct obstruction with Bilitec 2000.Materials and methodsMaterialsThirty - seven less than 4 - month old infants (25 males and 12 females; age 2-16 weeks, average 5. 3 weeks ) evaluated for cholestasis participated in this study between 06/2002 and 01/2005. Patients were divided into BA group (11 males and 6 females; age 2 ~ 16 weeks,average 5.7 weeks) and IHS group (14 males and 6 females; age 3-16 weeks, average 5 weeks) according to confirmed diagnosis post surgery or supportive treatments . Bilirubin exposure in the duodenum was measured with the Bilitec 2000 device in total thirty - seven subjects.MethodsTotal 37 subjects have been nil for three hours prior to testing. The probe was passed transorally after calibrated in water then positioned into the third part of duodenum and confirmed with x - ray. Test started and lasted for 24 hours. Subjects were instructed to take usual formula or breast feeding. The original charts of bilirubin absorbance values were recorded and investigation data included highest absorbance value, number of episodes longer than 5. 0 minutes, total time bilirubin absorbance ≥ 0. 14 u and 0. 25 u, percentages of total time absorbance ≥0. 14 u and 0.25 u,which were analyzed with use of adapted program Esophogram software ( Gastrosoft, Dallas, Texas, USA ) and stored in computer.Statistical analysisValues are expressed as medium (range). Data for the two groups was compared using two - tailed Wilcoxon test and Spearman's rank test was used for correlations. P<0.050 was considered statistically significant.Results1. When 0. 25 u was used as threshold absorbance value for the presence of bilirubin, bilirubin was detected in duodenum in none of the 17 BA infants, and was present in 18 of the 20 IHS infants. The Ace (accuracy) ,Spe (specifity) and Sen ( sensivity ) , + PV ( positive predictive value) , - PV ( negative predictive value) were 95% ,90% ,100% ,90% and 90% respectively.2. The percentages of total time absorbance≥0. 14 u and 0. 25 u were 0(0 ~4. 3% ) and 0(0 ~0) respectively in BA group. While the same kind of datain IHS group were 72. 6% ( 1. 6 ~ 100% ) and 31. 6% (0 ~ 100% ) . The difference was significant (p <0. 001). The highest absorbance value in BA infants was significantly lower than that in IHS infants( (0.12 u(0.08 -0.24 u) versus 0.59 u(0.2~0.87 u),P<0.001)).The serum GGT levels were significantly related to either the highest absorbance values (r= -0. 536,p =0. 001) or the percentages of total time absorbance≥0. 14 u(r= -0.599, p= 0.002) in total 37 subjects.
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