OBJECTIVETo investigate the value of dynamic examination of duodenal fluid in the differential diagnosis of infantile hepatitis syndrome (IHS) and extrahepatic biliary atresia (EHBA). The aim of the study was to establish a simple, rapid and accurate diagnostic procedure for infantile cholestatic jaundice.

METHODSThe authors developed a special duodenal drainage-tube and established a specific duodenal fluid drainage technique. The duodenal fluids were collected and the colors were documented. The bilirubin, gamma-glutamyltranspeptidase (gamma-GT) and bile acid concentrations in the duodenal fluids were measured.

RESULTSDuodenal fluid drainages were initially performed on 561 cases of infants with cholestatic jaundice. The yellow duodenal fluids were drained within 3-8 minutes after intubation in 342 cases. The yellow fluids were obtained in more patients after continuous drainage for 24 hours (21 cases) and 48-72 hours (16 cases), respectively. The duodenal fluids were light yellowish in 71 cases and white in 111 cases. The drainage techniques were subsequently performed in 182 infants with light yellowish or white duodenal fluids after conservative treatment. The duodenal fluids were yellow in 91 cases, white in 89 cases, and slightly yellowish in 2 cases. The increased levels of bilirubin (> or = 8.5 micromol/L), gamma-GT (> 20 IU/L) and bile acid (positive or 33-260 micromol/L) were observed in the yellow duodenal fluids. While the bilirubin levels were 0-2 micromol/L or 5-8 micromol/L in the white or slightly yellowish duodenal fluids, with gamma-GT levels at 0-5 IU/L and bile acid tested negative. According to the criteria set as bilirubin > or = 8.5 micromol/L, bile acid tested positive and gamma-GT > 20 IU/L in duodenal fluid, 470 infants were diagnosed as HIS; 91 cases were diagnosed as EHBA with duodenal fluid bilirubin < 8.5 micromol/L, bile acid tested negative and gamma-GT < 20 IU/L. The diagnoses of these patients were confirmed by surgical operation.

CONCLUSIONDynamic examination of duodenal fluid is a simple, rapid, safe and reliable method in the differential diagnosis of infantile cholestatic jaundice.