Acta Biomedica Scientia

PROSPECTIVE EVALUATION OF HEPATIC SHEAR WAVE ELASTOGRAPHY FOR ASSESSING LIVER FIBROSIS IN BILIARY ATRESIA: CORRELATION WITH HISTOPATHOLOGY AND SURGICAL OUTCOMES

Lakshmi Tilak S1, Hemanth Kumar M

drpebyreddy@gmail.com

Biliary Atresia, Shear Wave Elastography, Liver Biopsy, Kasai Portoenterostomy, Liver Fibrosis, Cholestasis, Postoperative Outcomes

Biliary atresia (BA) is a severe pediatric liver disorder that requires early diagnosis and surgical intervention via Kasai portoenterostomy (KPE) to optimize outcomes. This study evaluates the role of shear wave elastography (SWE) and liver biopsy in assessing preoperative liver status and predicting postoperative outcomes in BA patients. Methods: Of 40 patients evaluated for suspected BA, 32 met the inclusion criteria. Preoperative SWE values, liver biopsy scores, and clinical parameters were analyzed for correlations and predictive utility. Postoperative outcomes, including bile flow restoration, elastography trends, and biochemical markers, were assessed at 3 and 6 months. Results: The median age at surgery was 72 days, with a mean preoperative SWE value of 13.49 ± 3.81 kPa. Preoperative elastography and liver biopsy scores were significantly correlated (rho = 0.61, p = 0.003). At 3 months post-surgery, 47% of patients achieved patent bilioenteric drainage. SWE values and biopsy scores were significantly lower in the patent group compared to the nonpatent group (SWE: 13.97 ± 3.12 vs. 15.92 ± 3.94 kPa, p = 0.059; biopsy: 9.0 ± 1.54 vs. 10.83 ± 0.98, p < 0.05). The patent group showed a gradual decrease in SWE values over time, while the non-patent group exhibited a sharp increase. Total bilirubin and gamma-glutamyltransferase (GGT) levels were significantly lower in the patent group at 3 months (bilirubin: 3.92 ± 1.61 vs. 12.08 ± 2.08 mg/dL, p = 0.001; GGT: 517.25 ± 205.15 vs. 941.50 ± 363.86 IU/L, p = 0.002). Discussion and Conclusion:SWE and liver biopsy provide complementary insights into preoperative liver status and postoperative prognosis in BA patients. SWE trends and histopathological findings highlight their potential as valuable tools for early diagnosis, surgical decision-making, and postoperative monitoring. Early intervention and meticulous follow-up are critical for improving outcomes in BA.