Abstract
Aim Increasing evidence indicates that hepatic subcapsular flow (HSF) can serve as a noninvasive ultrasonographic marker for the early diagnosis of biliary atresia (BA). However, results regarding its diagnostic accuracy are inconsistent and inconclusive. We conducted this meta-analysis with an aim to systematically evaluate the diagnostic value of HSF in predicting BA. Methods A comprehensive literature search of four databases was conducted to identify the eligible studies. All analyses were performed using STATA 12.0. Results Nine studies from eight articles containing 368 patients and 469 controls were included in our meta-analysis. Briefly, the values for pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) were 0.95 (95% CI 0.88-0.98), 0.92 (95% CI 0.85-0.96), 11.6 (95% CI 6.3-21.5), 0.06 (95% CI 0.02-0.14), 201 (95% CI 59-689), and 0.98 (95% CI 0.96-0.99), respectively. Additionally, metaregression along with subgroup analysis based on various covariates revealed the potential sources of heterogeneity and the detailed diagnostic value in each subgroup. Conclusion Our meta-analysis showed that HSF assay could provide high accuracy in predicting BA patients and non-BA individuals. However, further studies with better design and larger sample size are required to support the results of the present study.
Highlights
Biliary atresia (BA), a rare neonatal cholangiopathy of unknown etiology, can rapidly progress to biliary cirrhosis and early death [1]
Our meta-analysis showed that hepatic subcapsular flow (HSF) assay could provide high accuracy in predicting BA patients and non-BA individuals
180 articles were excluded as they were reviews and letters or were not related to the theme of BA or HSF
Summary
Biliary atresia (BA), a rare neonatal cholangiopathy of unknown etiology, can rapidly progress to biliary cirrhosis and early death [1]. The current mainstay treatment for BA is the Kasai portoenterostomy, whose prognosis is found to be related to the timing of surgical intervention [2, 3]. It is very difficult to differentiate BA cases from non-BA cases, especially within the first 60 days of life, and many patients cannot receive the optimal surgical treatment of Kasai portoenterostomy [5, 6]. Patients may occasionally lack the symbolic signature for the early diagnosis of BA; many of them may miss the optimal timing of surgical treatment. Some markers and examinations have been proved distinct and have the potential for diagnosis of BA, an individual, ideal method has not yet been acknowledged
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