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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Use of shear wave elastography for the diagnosis and follow-up of biliary atresia: A meta-analysis
Ellen S Wagner, Hussien Ahmed H Abdelgawad, Meghan Landry, Belal Asfour, Mark B Slidell, Ruba Azzam
Ellen S Wagner, Ruba Azzam, Pediatric Gastroenterology, Hepatology, and Nutrition, The University of Chicago Medicine, Comer Children’ s Hospital, Chicago, IL 60637, United States
Hussien Ahmed H Abdelgawad, Department of Medicine, Zagazig University, Zagazig 44511, Egypt, Egypt
Meghan Landry, Department of Pediatrics, The University of Chicago Medicine, Comer Children’ s Hospital, Chicago, IL 60637, United States
Belal Asfour, Graduate School of Professional Education-Biomedical Informatics, University of Chicago, Chicago, IL 60637, United States
Mark B Slidell, Department of Surgery, The University of Chicago Medicine, Comer Children’ s Hospital, Chicago, IL 60637, United States
Author contributions: Wagner ES performed literature search, data acquisition and interpretation, manuscript drafting, and final approval; Abdelgawad HAH performed data acquisition, statistical analysis and interpretation, manuscript structure, drafting, and revisions; Landry M performed statistical analysis and interpretation, manuscript structure and revisions; Asfour B performed figure compilation and manuscript revisions; Slidell MB performed manuscript compilation, revisions, and final approval; Azzam R performed project structure, data acquisition and interpretation, manuscript revisions, and final approval.
Conflict-of-interest statement: There are no conflicts of interest to report.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ruba Azzam, MD, MPH, Associate Professor, Pediatric Gastroenterology, Hepatology, and Nutrition, The University of Chicago Medicine, Comer Children’ s Hospital, 5841 S Maryland Ave MC 4065, Chicago, IL 60637, United States. razzam@peds.bsd.uchicago.edu
Received: May 1, 2022
Peer-review started: May 1, 2022
First decision: June 19, 2022
Revised: July 10, 2022
Accepted: July 31, 2022
Article in press: July 31, 2022
Published online: August 28, 2022
BACKGROUND
Timely differentiation of biliary atresia (BA) from other infantile cholestatic diseases can impact patient outcomes. Additionally, non-invasive staging of fibrosis after Kasai hepatoportoenterostomy has not been widely standardized. Shear wave elastography is an ultrasound modality that detects changes in tissue stiffness. The authors propose that the utility of elastography in BA can be elucidated through meta-analysis of existing studies.
AIM
To assess the utility of elastography in: (1) BA diagnosis, and (2) post-Kasai fibrosis surveillance.
METHODS
A literature search identified articles that evaluated elastography for BA diagnosis and for post-Kasai follow-up. Twenty studies met criteria for meta-analysis: Eleven for diagnosis and nine for follow-up post-Kasai. Estimated diagnostic odds ratio (DOR), sensitivity, and specificity of elastography were calculated through a random-effects model using Meta-DiSc software.
RESULTS
Mean liver stiffness in BA infants at diagnosis was significantly higher than in non-BA, with overall DOR 24.61, sensitivity 83%, and specificity 79%. Post-Kasai, mean liver stiffness was significantly higher in BA patients with varices than in patients without, with DOR 16.36, sensitivity 85%, and specificity 76%. Elastography differentiated stage F4 fibrosis from F0-F3 with DOR of 70.03, sensitivity 96%, and specificity 89%. Elastography also differentiated F3-F4 fibrosis from F0-F2 with DOR of 24.68, sensitivity 85%, and specificity 81%.
CONCLUSION
Elastography has potential as a non-invasive modality for BA diagnosis and surveillance post-Kasai. This paper’s limitations include inter-study method heterogeneity and small sample sizes. Future, standardized, multi-center studies are recommended.
Core Tip: Ultrasound elastography is an emerging, non-invasive imaging modality to detect organ stiffness. It may be a useful tool in biliary atresia (BA) diagnosis and post-Kasai fibrosis surveillance. In a meta-analysis of twenty existing studies (eleven for diagnosis and nine for follow-up), this paper shows that mean liver stiffness is significantly higher in BA patients compared to non-BA patients at time of diagnosis. Post-Kasai, elastography can differentiate between early and advanced fibrosis as well as help to discern the presence or absence of varices. While there are limitations to this analysis, elastography shows great promise for its utility as a non-invasive modality for BA patients.
