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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
ARTICLE HIGHLIGHTS
Research background
Biliary atresia (BA) is a progressive infantile cholestatic disease. Diagnosis is confirmed by intra-operative cholangiogram; any delays to diagnosis and palliating Kasai hepatoportoenterostomy can increase the odds of needing liver transplant. Following Kasai, patients will need surveillance for progression of liver disease, which often requires liver biopsy.
Research motivation
Because the diagnosis and surveillance of BA both involve invasive procedures, there are risks for delay and/or adverse outcomes at each stage. By using non-invasive shear wave elastography (SWE), which measures changes in tissue stiffness, to identify liver stiffness thresholds for BA diagnosis and evolution of fibrosis post-Kasai, clinicians may be able to accurately diagnose and surveil BA without invasive procedures.
Research objectives
The authors performed a meta-analysis on studies into the utility of SWE for BA diagnosis and post-Kasai surveillance in order to determine whether existing literature could help identify liver stiffness thresholds for BA diagnosis and development of fibrosis post-Kasai.
Research methods
A literature search yielded twenty studies, eleven for diagnosis and nine for follow-up post-Kasai. Diagnostic odds ratio (DOR), sensitivity, and specificity of elastography were calculated through a random-effects model.
Research results
Mean liver stiffness in BA infants was higher than in cholestatic infants without BA with DOR 24.61, sensitivity 83%, specificity 79%. Mean liver stiffness post-Kasai was significantly higher in patients with varices than those without (DOR 16.36, sensitivity 85%, specificity 76%). SWE differentiated METAVIR F4 fibrosis from F0-F3 (DOR 70.03, sensitivity 96%, specificity 89%) as well as F3-F4 fibrosis from F0-F2 (DOR 24.68, sensitivity 85%, specificity 81%).
Research conclusions
SWE may be a useful, non-invasive modality for the diagnosis and post-Kasai surveillance in BA. The analysis is limited by methodological heterogeneity between studies as well as small sample sizes.
Research perspectives
In order for SWE to be useful for future BA cases, larger, standardized, multi-center studies are recommended to establish appropriate protocols.
