Pre-operative screening for biliary atresia in cholestatic infants: A case for percutaneous liver biopsy

We read the article by Okazaki, et al. [1] with interest and would like to take issue with some of their conclusions. This article was a review of 132 cases of suspected biliary atresia (BA) from 1998 to 2018. They argue that laparoscopy, in addition to “basic” studies (including blood biochemistries, ultrasound, and PMT hepatobiliary scintigraphy), are sufficient to reach a diagnosis of BA and that the former standard, pre-operative needle liver biopsy is unnecessary by both delaying treatment and being, in their words, “obsolete”.