Published online Aug 28, 2022. doi: 10.3748/wjg.v28.i32.4726
Peer-review started: May 1, 2022
First decision: June 19, 2022
Revised: July 10, 2022
Accepted: July 31, 2022
Article in press: July 31, 2022
Published online: August 28, 2022
Processing time: 116 Days and 9.4 Hours
Biliary atresia (BA) is a progressive infantile cholestatic disease. Diagnosis is confirmed by intra-operative cholangiogram; any delays to diagnosis and palliating Kasai hepatoportoenterostomy can increase the odds of needing liver transplant. Following Kasai, patients will need surveillance for progression of liver disease, which often requires liver biopsy.
Because the diagnosis and surveillance of BA both involve invasive procedures, there are risks for delay and/or adverse outcomes at each stage. By using non-invasive shear wave elastography (SWE), which measures changes in tissue stiffness, to identify liver stiffness thresholds for BA diagnosis and evolution of fibrosis post-Kasai, clinicians may be able to accurately diagnose and surveil BA without invasive procedures.
The authors performed a meta-analysis on studies into the utility of SWE for BA diagnosis and post-Kasai surveillance in order to determine whether existing literature could help identify liver stiffness thresholds for BA diagnosis and development of fibrosis post-Kasai.
A literature search yielded twenty studies, eleven for diagnosis and nine for follow-up post-Kasai. Diagnostic odds ratio (DOR), sensitivity, and specificity of elastography were calculated through a random-effects model.
Mean liver stiffness in BA infants was higher than in cholestatic infants without BA with DOR 24.61, sensitivity 83%, specificity 79%. Mean liver stiffness post-Kasai was significantly higher in patients with varices than those without (DOR 16.36, sensitivity 85%, specificity 76%). SWE differentiated METAVIR F4 fibrosis from F0-F3 (DOR 70.03, sensitivity 96%, specificity 89%) as well as F3-F4 fibrosis from F0-F2 (DOR 24.68, sensitivity 85%, specificity 81%).
SWE may be a useful, non-invasive modality for the diagnosis and post-Kasai surveillance in BA. The analysis is limited by methodological heterogeneity between studies as well as small sample sizes.
In order for SWE to be useful for future BA cases, larger, standardized, multi-center studies are recommended to establish appropriate protocols.