Journal of Pediatric Gastroenterology and Nutrition

Original Article: Hepatology

Prophylactic Antibiotics to Prevent Cholangitis in Children with Biliary Atresia After Kasai Portoenterostomy: A Meta-Analysis

Fatima Safira Alatas MD, PhD

Department of Child Health, Gastrohepatology Division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

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Glen Lazarus MD,

Glen Lazarus MD

Department of Child Health, Gastrohepatology Division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

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Michelle Clarissa Junaidi MD,

Michelle Clarissa Junaidi MD

Department of Child Health, Gastrohepatology Division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

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Hanifah Oswari MD, PhD,

Corresponding Author

Hanifah Oswari MD, PhD

[email protected]

Department of Child Health, Gastrohepatology Division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

Address correspondence and reprint requests to Prof Hanifah Oswari, MD, PhD, Department of Child Health, Gastrohepatology Division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Salemba 6, Jakarta 10430, Indonesia (e-mail: [email protected]).Search for more papers by this author

Fatima Safira Alatas MD, PhD,

Fatima Safira Alatas MD, PhD

Department of Child Health, Gastrohepatology Division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

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Glen Lazarus MD,

Glen Lazarus MD

Department of Child Health, Gastrohepatology Division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

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Michelle Clarissa Junaidi MD,

Michelle Clarissa Junaidi MD

Department of Child Health, Gastrohepatology Division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

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Hanifah Oswari MD, PhD,

Corresponding Author

Hanifah Oswari MD, PhD

[email protected]

Department of Child Health, Gastrohepatology Division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

First published: 14 September 2023

https://doi.org/10.1097/MPG.0000000000003935

Citations: 7

Data Access: The data supporting the findings of this study are available within the article and/or its supplementary materials.

The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org).

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Abstract

Objectives:

A connection between the bowel and bile ducts after the Kasai hepatoportoenterostomy (HPE) procedure poses a risk of ascending cholangitis. There were only a few evidence-based consensuses on the benefits of prophylactic antibiotics. This study aims to assess the value of prophylactic antibiotics in reducing the risk of cholangitis following the Kasai HPE procedure.

Methods:

Meta-analysis is performed using random-effects model from the search result of 5 online databases (PubMed, Google Scholar, EBSCO MEDLINE, ClinicalTrials.gov, and EuropePMC) from inception to October 27, 2021. The keywords used were “antibiotic,” “antimicrobial,” “Kasai,” “portoenterostomy,” “biliary atresia,” and “bile duct atresia.” Cochrane Risk of Bias tool and Newcastle-Ottawa Scale is used to assess the risk of bias. The outcomes are incidence of cholangitis and native liver survival.

Results:

Six studies consisting of 4 cohorts and 2 cross-sectional studies were extracted. A total of 714 patients reported different cholangitis incidence after prophylactic antibiotics administration post-Kasai HPE. The incidence of cholangitis following Kasai HPE was not statistically significant among participants. There is conflicting evidence on the efficacy of antibiotics in prolonging native liver survival.

Conclusions:

The existing evidence does not support the administration of prophylactic antibiotics in preventing cholangitis after Kasai HPE among biliary atresia patients. Additionally, their roles in native liver survival are still inconclusive. The fact that there were heterogeneous method and antibiotic usage between existing studies must also be highlighted for better design in future studies.

Graphical Abstract

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Volume77, Issue5

November 2023

Pages 648-654