OBJECTIVE: Biliary atresia (BA) is the main cause of liver damage that can progress to liver cirrhosis. The current gold standard for the diagnosis is liver biopsy which are invasive and not available in every center. Duodenal aspiration test (DAT) was a simple method that can rule out BA. The aim of this study was to study the test performance of DAT in diagnosing BA.
METHOD: We retrospectively reviewed the data of 100 patients suspected with BA from 2016 to 2019 in Dr. Soetomo Academic General Hospital Surabaya. Suspicious BA was based on the present of prolonged jaundice, acholic stool, and increased of bilirubin serum. All children were performed both DAT and liver biopsy. DAT was considered bile positive when the fluid contain of bile acid. The percutaneous liver biopsy was performed by pediatric hepatologist. Histopathological parameters including ductal proliferation, bile plugs and intracellular bile pigments as the indicator of positive BA. We calculate sensitivity, specificity, negative and positive predictive values (NPV and PPV), and likehodd-liked ratio (LLR) of DAT compared to liver biopsy.
RESULT: Sixty five patients were female and the median age at diagnosis was 20(4-55) months. Sixty (60%) children were diagnosed as BA. Negative bilirubin from DAT was found in 52/60 (87%) in BA group and 15/25 (60%) in non BA group (p<0.001). Diagnostic analysis for DAT compared liver biopsy revealed sensitivity of 87(95% CI 79 to 95)%, specificity of 63(95% CI 47-78)%, PPV of 78(95% 68 to 88)%, and NPV of 76(95%CI 61 to 90)%. The positive LLR was 2.31 (95%CI 1.53 to 3.49) and negative LLR was 0.21 (95%CI 0.11 to 0.42).
CONCLUSION: DAT has a good screening performance for BA. A negative DAT result indicates for further evaluation of liver biopsy to diagnose biliary atresia.