Biliary Atresia Treatment: Can Shear Wave Elastography Predict Kasai Procedure Outcomes?

doi:10.37015/AUDT.2025.240005

Abstract

Abstract:

Objective Biliary atresia is a significant cause of neonatal pathological jaundice, demanding effective interventions such as the Kasai procedure to impede its advancement. Previous research highlights the potential of shear wave elastography for assessing liver fibrosis and the subsequent necessity for liver transplantation following Kasai procedure. This underlines the significance of our study in investigating shear wave elastography as a predictive tool for the success of Kasai procedure in biliary atresia patients.

Methods This retrospective case-control comparative study analyzed data from biliary atresia patients who underwent shear wave elastography ultrasound and the Kasai procedure at our center from 2020 to 2022. Successful Kasai outcomes formed the case group; unsuccessful, the control. We calculated the mean shear wave elastography values for each group and established a predictive Kasai success cut-off using SPSS for statistical analysis.

Results Twenty-one subjects, with 8 males and 13 females (median age: 82 days), were evaluated. Of the 21 subjects, 9 (42.9%) had successful Kasai outcomes, while 12 (57.1%) were unsuccessful. There are statistically different values between two groups, such as the shear wave elastography value (P = 0.001). The optimal cut-off point of shear wave elastography value to predict the success of Kasai procedure is 2.21 m/s or 14.4 kPa (sensitivity 88.9%, specificity 83.3%, accuracy 85.7%, PPV 87.65%, NPV 84.91%), with an AUC of 0.889 (95%CI = 0.75-1.00), OR = 10.50 (1.360-81.053).

Conclusion This study demonstrates shear wave elastography’s potential utility in predicting Kasai procedure success for biliary atresia patients, suggesting its role as a valuable prognostic tool.

Key words: Biliary atresia; Shear wave elastography; Kasai procedure

Sekarsari Damayanti, Gema Ramadhan Muhammad, Rinaldhy Kshetra, Prihartono Joedo. Biliary Atresia Treatment: Can Shear Wave Elastography Predict Kasai Procedure Outcomes?. Advanced Ultrasound in Diagnosis and Therapy, 2025, 9(1): 84-91.

Figures/Tables 5

Figure 1

Table 1

Figure 2

Table 2

Table 3

References 21

[1]	Woodgate P, Jardine LA. Neonatal jaundice. BMJ Clin Evid 2011;2011:0319.
[2]	Haafiz AB. Liver fibrosis in biliary atresia. Expert Rev Gastroenterol Hepatol 2010;4:335-343.
[3]	J. Bisanto. Evaluasi Diagnosis dan Tatalaksana Kolestasis pada Bayi, BKGAI 07 Kongr Nas III (2007) 75-89.
[4]	Shteyer E, Ramm GA, Xu C, White FV, Shepherd RW. Outcome after portoenterostomy in biliary atresia: pivotal role of degree of liver fibrosis and intensity of stellate cell activation. J Pediatr Gastroenterol Nutr 2006;42:93-99.
[5]	Bedossa P, Dargère D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 2003;38:1449-1457.
[6]	Caruso M, Cuocolo R, Di Dato F, Mollica C, Vallone G, Romeo V, et al. Ultrasound, shear-wave elastography, and magnetic resonance imaging in native liver survivor patients with biliary atresia after Kasai portoenterostomy: correlation with medical outcome after treatment. Acta Radiol 2020;61:1300-1308.
[7]	B.L. Shneider, M.B. Brown, B. Haber, P.F. Whitington, K. Schwarz, R. Squires, et al. Biliary Atresia Research Consortium, A multicenter study of the outcome of biliary atresia in the United States, 1997 to 2000. J Pediatr 2006;148:467-474.
[8]	Gunadi, Sirait DN, Budiarti LR, Paramita VMW, Fauzi AR, Ryantono F, et al. Histopathological findings for prediction of liver cirrhosis and survival in biliary atresia patients after Kasai procedure. Diagn Pathol 2020;15:79.
[9]	Matos H, Trindade A, Noruegas MJ. Acoustic radiation force impulse imaging in paediatric patients: normal liver values. J Pediatr Gastroenterol Nutr 2014;59:684-688.
[10]	Shen Q, Chen Y, Peng C, Pang W, Wang Z, Wu D, et al. Liver stiffness measurement predicts the difficulty of Kasai procedure in biliary atresia: a single center retrospective analysis of 199 patients. BMC Pediatr 2019;19:465.
[11]	Lee KJ, Kim JW, Moon JS, Ko JS. Epidemiology of Biliary Atresia in Korea. J Korean Med Sci 2017;32:656-660.
[12]	Apfeld JC, Cooper JN, Sebastião YV, Tiao GM, Minneci PC, Deans KJ. Variability in age at Kasai portoenterostomy for biliary atresia across US children’s hospitals. J Pediatr Surg 2021;56:1196-1202.
[13]	Khayat A, Alamri AM, Saadah OI. Outcomes of late Kasai portoenterostomy in biliary atresia: a single-center experience. J Int Med Res 2021;49:3000605211012596.
[14]	Uecker M, Kuebler JF, Schukfeh N, Pfister ED, Baumann U, Petersen C, et al. Kasai procedure in patients older than 90 days: Worth a cut, Eur. Eur J Pediatr Surg 2022;32:80-84.
[15]	M. Nio, R. Ohi, Biliary atresia. Semin. Pediatr. Surg 2000;9:177-186.
[16]	Baruah RR, Bhatnagar V, Agarwala S, Gupta SD. Correlation of pre- and post-operative liver function, duct diameter at porta hepatis, and portal fibrosis with surgical outcomes in biliary atresia. J Indian Assoc Pediatr Surg 2015;20:184-188.
[17]	Yoon H, Ihn K, Kim J, Lim HJ, Park S, Han SJ, et al. Pre- and Immediate post-kasai portoenterostomy shear wave elastography for predicting hepatic fibrosis and native liver outcomes in patients with Biliary Atresia. Korean J Radiol 2023;24:465-475.
[18]	Ding C, Wang Z, Peng C, Pang W, Tan SS, Chen Y. Diagnosis of liver cirrhosis with two-dimensional shear wave elastography in biliary atresia before Kasai portoenterostomy. Pediatr Surg Int 2022;38:209-215.
[19]	Friedrich-Rust M, Nierhoff J, Lupsor M, Sporea I, Fierbinteanu-Braticevici C, Strobel D, et al. Performance of acoustic radiation force impulse imaging for the staging of liver fibrosis: a pooled meta-analysis. J Viral Hepat 2012;19:e212-219.
[20]	Hanquinet S, Courvoisier DS, Rougemont AL, Wildhaber BE, Merlini L, McLin VA, et al. Acoustic radiation force impulse sonography in assessing children with biliary atresia for liver transplantation. Pediatr Radiol 2016;46:1011-1016.
[21]	Khanna K, Bhatnagar V, Agarwala S, Srinivas M, Gupta SD. Ratio of preoperative and postoperative serum bilirubin levels predicts early outcome following Biliary atresia surgery. J Indian Assoc Pediatr Surg 2018;23:81-86.

Parameters	All	Kasai Procedure		P value
Parameters	All	Successful (n = 9)	Unsuccessful (n = 12)	P value
Age, days	82 (15)	79 (15)	85 (11)	0.148^*
SWE velocity, m/s	2.32 ± 0.89	1.65 ± 0.59	2.83 ± 0.73	0.001
Pre-Kasai bilirubin, mg/dL	10.13 (5)	8.45 (1.96)	11.98 (6.01)	0.004^*
Pre-Kasai AST, IU/L	183 (107)	180 (134)	190.5 (121)	0.508^*
Pre-Kasai ALT, IU/L	139 (77)	139 (60)	132 (85)	0.917^*
Pre-Kasai GGT, U/L	981.9 ± 473.56	936.3 ± 603.14	1016.08 ± 374.44	0.713

Characteristics	Kasai procedure		P value	OR (CI 95%)
Characteristics	Successful (n = 9)	Unsuccessful (n = 12)	P value	OR (CI 95%)
Gender
Male	5	3	0.166^*	3.75 (0.59-23.94)
Female	4	9
Age groups
39-75 days	3	2	0.353^*	2.50 (0.32-19.53)
76-94 days	6	10
SWE value
< 2.21 m/s	7	3	0.024^*	10.50 (1.36-81.05)
> 2.21 m/s	2	9
Pre-Kasai bilirubin
< 9.85 mg/dL	7	3	0.024^*	10.50 (1.36-81.05)
> 9.85 mg/dL	2	9

	Variables	Coefficient	P value	OR (CI 95%)
Step 1	SWE value	21.252	0.999	1.697E+9
	Pre-Kasai bilirubin	1.446	0.242	4.244 (0.376-37.920)
	Age of Kasai procedure	20.735	0.999	1.012E+9
	Constant	-65.408	0.999	0.00
Step 2	SWE value	1.894	0.095	6.647 (0.721- 61.307)
	Pre-Kasai bilirubin	1.894	0.095	6.647 (0.721-61.307)
	Constant	-5.327	0.021	0.005