Histopathological features and accuracy for diagnosing biliary atresia by prelaparotomy liver biopsy in Egypt

Background and study aimsBiliary atresia (BA) is the most common cause of chronic cholestasis in infants. The most important objective in such cases is to distinguish obstructive cholestasis from non-obstructive causes.Aim of the studyTo evaluate the hepatic histopathology for the presence of features that correlate best with the diagnosis of BA.Patients and methodsWe retrospectively study the data of 81 infants who presented with neonatal cholestatic syndrome (NCS) (58 diagnosed as BA and 23 as not BA). We evaluated 6 histopathological parameters including ductular proliferation, bile plugs, intracellular bile pigments, giant cells transformation, Portal cellular infiltration and fibrosis.ResultsThe study showed that ductular proliferation, bile plugs and intracellular bile pigments emerged as the best indicators of BA while multinucleate giant cells transformation and portal cellular infiltration were seen in NH.ConclusionIn developing countries, we therefore recommend doing prelaparotomy liver biopsy for all suspected cases of BA to decrease the frequency of negative laparotomy to achieve cost benefit with reduced morbidity.