Editor--The Children's Liver Disease Foundation recently published its report into the treatment of infants with biliary atresia by Kasai portoenterostomy.[1] This was covered in the BBC's news programme Northwest Tonight and in Trust Me, I'm a Doctor on 26 February. The report advocates that Kasai portoenterostomy should be performed only in centres that can produce outcome figures equivalent to those produced by group C in the table. Furthermore, the relevant professional bodies should encourage all surgeons to refer patients to such centres. Finally, it emphasises that all surgeons should fully inform parents about experience and outcome in their centre and the outcome of centres operating on more than five infants a year.
Outcome of Kasai portoenterostomy for extrahepatic biliary atresia, 1993-5
The foundation funded a survey by the British Paediatric Surveillance Unit of cases of extrahepatic biliary atresia occurring between 1993 and 1995. The preliminary data from this study (table), together with a previous study,[2] formed the basis of their recommendations. Median follow up was 3 years, with a successful Kasai procedure being determined by clearance of jaundice.
Unfortunately, the media representation of these data in the television programmes and elsewhere[3 4] has been inaccurate and misleading. Although importantly emphasising the differences between groups A and C and publicising the success of hospitals in group C, the acknowledgment of comparable success in the centres of group B was conspicuously absent.
Regional centres for paediatric gastroenterology should be encouraged to continue providing a service to the local community when they have experience in diagnosing and managing liver disease in children, satisfactory success rates for Kasai portoenterostomy, and established links with a supraregional or transplant centre for timely referral. Unnecessary centralisation will compromise affected families both socially and economically and undermine their confidence in well established units that have served their population effectively over decades.
We support the Children's Liver Disease Foundation in requesting further evaluation of the provision of Kasai portoenterostomy. This evaluation should assess the service provided by all centres wishing to continue providing Kasai portoenterostomy and should be performed by the relevant professional bodies and not the media.
[1] Children's Liver Disease Foundation. Report into the treatment of infants with biliary atresia by Kasai-portoenterostomy. Birmingham: Children's Liver Disease Foundation, 1999. (Available from Children's Liver Disease Foundation, 35-37 Great Charles Street, Queensway, Birmingham B3 3JY.)
[2] McClement JW, Howard ER, Mowat AP. Results of surgical treatment for extrahepatic biliary atresia in United Kingdom, 1980-2. BMJ 1985;290:345-7.
[3] MD. Doing the rounds. Private Eye 1998 Aug 21:12.
[4] MD. Doing the rounds. Private Eye 1998 Sep 4:12.
S Davison Consultant in paediatric gastroenterology
V Miller Consultant in paediatric gastroenterology
A Thomas Consultant in paediatric gastroenterology
J Bowen Consultant in paediatric surgery
J Bruce Consultant in paediatric surgery
Departments of Paediatric Gastroenterology and Paediatric Surgery, Booth Hall Children's Hospital and Royal Manchester Children's Hospital, Manchester Children's Hospital NHS Trust, Manchester M27 1HA
COPYRIGHT 1999 British Medical Association
COPYRIGHT 2000 Gale Group
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