WOFAPS 2025 8th World Congress of Pediatric Surgery

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Poster - 290

Diagnostic Accuracy of Ultrasound and Transient Elastography in Biliary Atresia Among Infants with Neonatal Cholestasis

Rustam Yuldashev 1, Makhmud Aliev 2, Farrukh Nematjonov 3, Golib Tuychiev 4, Anvar Gofurov 3, Roksana Shakirova 1
1 Republican specialized scientific practical medical center of pediatrics
2 Tashkent state medical university
3 Andijan state medical institute
4 Kokand university, Andijan branch

Purpose: To evaluate the efficacy of abdominal ultrasound (US) and transient elastography (TE) in early diagnosis of presumed biliary atresia (BA) among infants presenting with neonatal cholestasis.

Methods: This retrospective single-center study involved 157 infants with neonatal cholestasis admitted to the Republican Specialized Scientific-Practical Medical Center of Pediatrics (RSSPMCP) in Tashkent between 2013 and 2023. Initial evaluations were partly conducted at two regional centers, followed by detailed diagnostics at RSSPMCP. The diagnostic algorithm included abdominal ultrasound, transient elastography, and selective hepatobiliary scintigraphy. BA was surgically confirmed via intraoperative cholangiography or liver biopsy in 43 cases, while 88 were classified as presumed BA based on clinical presentation, ultrasound, and elastography findings. Non-BA cases were differentiated through clinical, laboratory, imaging, and genetic investigations when indicated.

Results: Presumed BA was identified in 131 (83.4%) infants, with 43 cases confirmed surgically. Ultrasound criteria indicative of BA included the triangular cord sign (38.3%) and gallbladder abnormalities (65.5%). A normal gallbladder was present in 35.8% of presumed BA cases, indicating limited sensitivity of US alone. TE showed significantly increased liver stiffness in presumed BA cases (21.05±1.9 kPa) compared to non-BA (17.22±3.65 kPa; p<0.05), especially in patients older than 90 days. Hepatobiliary scintigraphy performed selectively in six cases confirmed absence of intestinal excretion in all BA cases, with two false positives in non-BA conditions.

Conclusion: Combined use of abdominal ultrasound and transient elastography significantly improves early non-invasive diagnosis of presumed BA, aiding timely surgical decision-making in infants with neonatal cholestasis.

Keywords: biliary atresia, neonatal cholestasis, ultrasound, transient elastography, diagnosis

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