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Medicine (Baltimore). 2018 Aug;97(35):e12005. doi: 10.1097/MD.0000000000012005.

Effect of combined ursodeoxycholic acid and glucocorticoid on the outcome of Kasai procedure: A systematic review and meta-analysis.

Author information

1
Pediatrics Department, Research Institute, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou.
2
Tropical Medicine Institute, Guangzhou University of Chinese Medicine.
3
Orthopedics Department, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou.
4
Acupuncture Department, Foshan Hospital of TCM, Affiliated of Guangzhou University of Chinese Medicine, Foshan.
5
Reproductive Medicine Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou.
6
Pediatrics Department, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.

Abstract

INTRODUCTION:

Multiple studies have investigated the effect of ursodeoxycholic acid (UDCA) or glucocorticoid (GC) on the outcome of the hepatoportoenterostomy (Kasai procedure) in patients with biliary atresia (BA). However, the combined effect of these drugs (UDCA + GC) is little understood.

METHODS:

This meta-analysis specifically evaluated the effect of UDCA + GC after the Kasai procedure in patients with BA. A comprehensive literature search was conducted for all relevant articles in the electronic databases Medline, PubMed, Cochrane, Excerpta Medica Database (EMBASE), China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database on Disc (CBM-disc), and Vendor Information Pages (VIP).

RESULTS:

Eight studies with BA patients were finally included in our meta-analysis. The 8 identified studies consisted of 3 case-control, 3 cohort, and 2 randomized controlled trials (RCTs) with overall 530 subjects (144, 152, and 234 subjects, respectively). Among them, 312 patients were treated with UDCA + GC, while 218 received placebo or other intervention. The meta-analysis indicated that groups that received UDCA + GC had significantly lower rates of postoperative jaundice relative to the controls (pooled, odds ratio [OR] = 2.41; 95% confidence interval [CI] 1.44-4.04; Z = 3.34; P = .0008), while rates of cholangitis were similar (pooled, OR = 0.87; 95% CI 0.43-1.74; Z = 0.40; P = .69).

CONCLUSIONS:

Combined UDCA and GC intervention was superior to that of the control in accelerating the clearance of serum bilirubin in patients with BA after the Kasai procedure. However, this conclusion requires further confirmation using RCTs of high methodological quality.

PMID:
30170405
PMCID:
PMC6393119
DOI:
10.1097/MD.0000000000012005
[Indexed for MEDLINE]
Free PMC Article

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