IPEG 2024 Round Table Discussion from East Asia - Dr. Eri Ueda (Abe)
With Dr. Dr. Eri Ueda (Abe)
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What the experts said
Patient was a girl with biliary atresia referred at 41 days of age with grayish stools starting at day 12
Laparoscopic Kasai was performed at 46 days of age, which was 34 days after symptom onset
The operation was performed mainly by bipolar instead of cautery
It took 2 months to be jaundice free after laparoscopic Kasai, which is longer than usual
Once jaundice-free, patient had good course without cholangitis or other problems and without any increase in bilirubin levels
Routine blood sampling showed anemia about one year after laparoscopic Kasai
GIF (gastrointestinal endoscopy) diagnosed esophageal varices
Before planned endoscopic treatment, patient had tarry stools and further anemia developed
Liver transplantation was performed as a result of portal hypertension, but bilirubin levels were still within normal range
Portal hypertension can develop even in the absence of jaundice
Conservation of hemoglobin check and GIF is needed even in jaundice-free patients
During the initial laparoscopic Kasai there was no injury to the portal vein or anything, dissection and anastomosis were just as usual
Post-operative state after initial Kasai was uneventful
Patient had no specific hypercoagulability of portal vein before the procedure
76% of audience performs gastrointestinal endoscopy as routine check after Kasai for biliary atresia
Routine checkup is performed at least once in 6 months, basically checking ultrasounds and blood sample tests, not GI endoscopy
Patient stayed only 5 days in ICU after liver transplantation
Patient started oral intake on postoperative day 7 after transplant
All drains were removed postoperative day 14 after transplant
Pediatricians routinely check bloods and ultrasound looking for splenomegaly
Portal vein pressure is not routinely checked
Routine panendoscopy is not performed to look for varices, only when symptoms occur
In one Korean center, endoscopic examination is not routinely performed but hepatic fibroscan or ultrasonography with elastography is checked
A cutoff line of F4 fibrosis at 9.4 kilopascal by fibroscan has been published for variceal surveillance
Variceal surveillance by endoscopy is performed once in a year or once in 2 years depending on gastroenterologist
Endoscopic surveillance timing depends on development or progression of liver fibrosis
Bile duct diameter is always checked during the operation