Clinical Significance of Duodenal Bile Acids in Differential Diagnosis for Infantile Jaundice -Duodenal Intubation in Infants with Cholestatic Jaundice-

Abstract

We evaluated the effectiveness of bile in duodenal fluid collected by intubation from neonates with severe cholestasis to differentiate biliary atresia. Eighty five infants with cholestatic jaundice and acholic stools were studied prospectively from November 1985 to July 1992. Forty nine patients had biliary atresia, 34 neonatal hepatitis, and 2 intrahepatic bile duct paucity. Almost all (47 of 49 infants) of the biliary atresia patients did not show bile in the duodenal fluid and most of the neonatal hepatitis cases (29 of 34 patients) revealed bile in the juice, whereas only 8 of 32 neonatal hepatitis patients demonstrated bowel radio-activity on DISIDA scan. Seventy six of 85 cholestatic jaundice patients could be diagnosed correctly by duodenal intubation bile study, and only 8 of 83 patients could be diagnosed by DISIDA scan only in this study. When DISIDA and duodenal intubation were carried out simultaneously, we could confirm the correct diagnosis in 77 of 83 patients before liver biopsy and operative cholangiogram. During the study, intubation did not cause any complication at all. These data suggest that duodenal intubation must be a superior method for the differentiation of cholestatic jaundice patients, and, moreover, it is simple, rapid and cheap.