{"title":"Late Referral of Biliary Atresia and Poor Clinical Outcomes.","authors":"Melinda Masturina, Rendi Aji Prihaningtyas, Bagus Setyoboedi, Sjamsul Arief","doi":"10.4166/kjg.2025.005","DOIUrl":null,"url":null,"abstract":"<p><strong>Background/aims: </strong>Biliary atresia (BA) is a progressive cholangiopathy in infants that often necessitates liver transplantation. This study aimed to evaluate the impact of delayed referral on clinical and histopathological outcomes in BA cases.</p><p><strong>Methods: </strong>This study was a prospective observational study conducted from January to September 2023 at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.</p><p><strong>Results: </strong>A total of 137 infants with cholestasis were enrolled. Of these, only 85 underwent liver biopsy, with 60 cases (70.6%) confirmed as extrahepatic cholestasis consistent with BA. Among these 60 BA-confirmed patients, 83.3% were referred after 60 days of age. Patients in the late referral group (>60 days) in all cases exhibited higher leukocyte counts, total bilirubin levels, prolonged prothrombin time, and hypoalbuminemia, reflecting a more advanced disease state. Two-phase ultrasonography detected abnormalities in 76.7% of BA-confirmed cases, supporting its potential role as a screening modality in resource-limited settings. Histopathological analysis revealed a significantly higher prevalence of liver fibrosis in patients referred after 60 days (p=0.002), indicating disease progression. Only 9 patients underwent Kasai portoenterostomy, with 8 fatalities due to ascending cholangitis.</p><p><strong>Conclusions: </strong>These findings emphasize the urgent need for earlier detection and referral to improve outcomes in infants with BA.</p>","PeriodicalId":94245,"journal":{"name":"The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi","volume":"85 3","pages":"382-388"},"PeriodicalIF":0.8000,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4166/kjg.2025.005","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
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Abstract
Background/aims: Biliary atresia (BA) is a progressive cholangiopathy in infants that often necessitates liver transplantation. This study aimed to evaluate the impact of delayed referral on clinical and histopathological outcomes in BA cases.
Methods: This study was a prospective observational study conducted from January to September 2023 at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Results: A total of 137 infants with cholestasis were enrolled. Of these, only 85 underwent liver biopsy, with 60 cases (70.6%) confirmed as extrahepatic cholestasis consistent with BA. Among these 60 BA-confirmed patients, 83.3% were referred after 60 days of age. Patients in the late referral group (>60 days) in all cases exhibited higher leukocyte counts, total bilirubin levels, prolonged prothrombin time, and hypoalbuminemia, reflecting a more advanced disease state. Two-phase ultrasonography detected abnormalities in 76.7% of BA-confirmed cases, supporting its potential role as a screening modality in resource-limited settings. Histopathological analysis revealed a significantly higher prevalence of liver fibrosis in patients referred after 60 days (p=0.002), indicating disease progression. Only 9 patients underwent Kasai portoenterostomy, with 8 fatalities due to ascending cholangitis.
Conclusions: These findings emphasize the urgent need for earlier detection and referral to improve outcomes in infants with BA.
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