Mark Davenport

Mark's statements about Biliary Atresia 72 statements

Biliary Atresia - Clinical Practice Updates

Quotation The key point about the biopsy is really to not go to theater to not have a general anesthetic and to not undergo an invasive investigation and to exclude all those I'll put it medical conditions that that sort of mimic biliary atresia. Open

Quotation We published quite a few years ago on infants that were coming to surgery for other matters who later turned out to have biliary atresia in the first week of life. They all had normal livers. So you can't really diagnose those early ones on liver biopsy, that's certainly true. Open

Statement Infants coming to surgery for other matters who later turned out to have biliary atresia in the first week of life all had normal livers, so you can't diagnose early biliary atresia on liver biopsy Open

Statement Liver histology looking at inflammation and fibrosis has not shown great discrimination for prognosis in babies coming to surgery before 100 days Open

Statement The key differential for a prenatally detected cyst is between cystic biliary atresia and a choledochal cyst Open

Statement If the baby is not jaundiced and not raising conjugated bilirubin, then it's not cystic biliary atresia and you can wait to do the laparotomy Open

Biliary Atresia Part I

Quotation The key thing is to show that you've got a conjugated hyperbilirubinemia. And if you've done that, then all else flows. Open

Statement The key diagnostic finding is conjugated hyperbilirubinemia. Open

Statement Ultrasound separates out other surgical issues including inspissated bile syndrome and spontaneous perforation of bile ducts, which should have ultrasound-positive features. Open

Statement The triangular cord sign on ultrasound is not particularly discriminatory for biliary atresia. Open

Statement Ultrasound separates out other surgical issues including inspissated bile syndrome and spontaneous perforation of bile ducts, which should have ultrasound-positive features. Open

Statement The triangular cord sign on ultrasound is not particularly discriminatory for biliary atresia. Open

Statement Experienced pathologists can diagnose biliary atresia from percutaneous liver biopsy in almost 90% of cases. Open

Statement King's College Hospital uses ERCP for approximately 10% of biliary atresia cases when biopsy findings are equivocal. Open

Quotation They're not made in America. Don't worry about that. It's a Japanese scope. Open

Statement Histologic findings diagnostic of biliary atresia include ductular proliferation, small cell infiltrate, and bile duct plugs in proliferating bile ducts. Open

Quotation The other pathognomonic finding for biliary atresia, as opposed to some of the other obstructive processes, is you'll see bile duct plugs in those bile ducts that are proliferating. Open

Statement By 50 days of age, all histologic features of biliary atresia should be established on biopsy, whereas earlier biopsies (10-20 days) may not show consistent diagnostic findings. Open

Quotation The other pathognomonic finding for biliary atresia, as opposed to some of the other obstructive processes, is you'll see bile duct plugs in those bile ducts that are proliferating. Open

Statement Histologic findings diagnostic of biliary atresia include ductular proliferation, small cell infiltrate, and bile duct plugs in proliferating bile ducts. Open

Statement By 50 days of age, all histologic features of biliary atresia should be established on biopsy, whereas earlier biopsies (10-20 days) may not show consistent diagnostic findings. Open

Quotation This is one of the last remaining examples of a maximally invasive operation. Open

Quotation Any kind of biliary ductules that transgress that just simply scar over. I've never seen any kind of coring of the liver that's achieved anything in the literature. Open

Quotation It's a beautiful thing to see, the surgical plane. You can almost strip it off. And the idea is there's nothing left. Open

Quotation Any kind of biliary ductules that transgress that just simply scar over. I've never seen any kind of coring of the liver that's achieved anything in the literature. Open

Quotation It's a beautiful thing to see, the surgical plane. You can almost strip it off. And the idea is there's nothing left. Open

Statement Coring into the liver creates an unstable interface that has never achieved good results in the literature, as biliary ductules that transgress simply scar over. Open

Statement Standard Roux limb length for Kasai portoenterostomy is 40 centimeters, though Cincinnati uses 35-40 cm and measures with silk suture to 45 cm. Open

Biliary Atresia Part II

Statement START trial subset analysis for patients <70 days old: placebo arm 57% jaundice clearance, steroid arm 72% clearance—difference not statistically significant due to insufficient numbers (type 2 error) Open

Statement King's College high-dose steroid protocol (5mg/kg/day): 67% jaundice clearance vs 52% in controls, difference reached statistical significance with larger numbers Open

Statement King's College initial low-dose steroid trial (2mg/kg/day prednisone): no difference in jaundice clearance between groups, but statistically significant lower bilirubin at one month in steroid group Open

Statement King's College high-dose steroid protocol (5mg/kg/day): 67% jaundice clearance vs 52% in controls, difference reached statistical significance with larger numbers Open

Statement King's College current protocol: 5mg/kg/day prednisone starting day 4 post-op when oral feeds begin Open

Statement GI bleeding is a potential steroid complication; King's College always gives ranitidine with steroids, which may not have been standard in START trial Open

Statement King's College antibiotic protocol: IV tazocin-gentamicin for 5 days, then oral cephalosporin for 1 month Open

Statement For patients presenting at 100+ days with cirrhosis on ultrasound (heterogeneous surface, ascites), consider primary transplant rather than Kasai; primary transplant rate in England/Wales is approximately 5% Open

Statement King's College data from 2001: 100+ day Kasai patients achieved approximately 40% five-year native liver survival Open

Statement For patients presenting at 100+ days with cirrhosis on ultrasound (heterogeneous surface, ascites), consider primary transplant rather than Kasai; primary transplant rate in England/Wales is approximately 5% Open

Statement King's College data from 2001: 100+ day Kasai patients achieved approximately 40% five-year native liver survival Open

Statement King's College data with high-dose steroids: 100% of patients who underwent Kasai before 30 days of age cleared their jaundice Open

Statement King's College does not use steroids for cholangitis treatment and does not perform early revision Kasai Open

Statement CMV IgM-positive biliary atresia represents approximately 10% of cases in Western Europe and North America; prevalence higher in China and Japan Open

Statement King's College prospective antiviral treatment (valganciclovir): 7 of 9 (approximately 78%) CMV-positive patients cleared jaundice, dramatic improvement from historical <10% Open

Statement King's College retrospective data (2010-11): CMV IgM-positive patients were older at Kasai, had different histology, and cleared jaundice in less than 10% of cases without antiviral treatment Open

Statement CMV PCR levels in biliary atresia show inverse relationship with age and AST levels; highest viral loads in younger babies, suggesting body clears virus over time Open

Quotation When we separated out the CMV positive and compared it with the CMV negative as a control, there was a dramatic difference, not only in their clinical characteristics, because the CMV positive were older by the time of their Kisai operation, but also the histology was different. And their outcomes were very different. Open

Quotation In the last analysis, we cleared jaunice in seven out of nine of them, which is about 70 odd percent. And that was a dramatic difference from what we'd experienced previously. Open

Statement King's College retrospective data (2010-11): CMV IgM-positive patients were older at Kasai, had different histology, and cleared jaundice in less than 10% of cases without antiviral treatment Open

Statement King's College prospective antiviral treatment (valganciclovir): 7 of 9 (approximately 78%) CMV-positive patients cleared jaundice, dramatic improvement from historical <10% Open

Statement CMV PCR levels in biliary atresia show inverse relationship with age and AST levels; highest viral loads in younger babies, suggesting body clears virus over time Open

Quotation When we separated out the CMV positive and compared it with the CMV negative as a control, there was a dramatic difference, not only in their clinical characteristics, because the CMV positive were older by the time of their Kisai operation, but also the histology was different. And their outcomes were very different. Open

Quotation In the last analysis, we cleared jaunice in seven out of nine of them, which is about 70 odd percent. And that was a dramatic difference from what we'd experienced previously. Open

Statement Increasing proportion of biliary atresia patients require transplant despite modest bilirubin elevation due to progressive fibrosis and portal hypertension complications Open

Statement King's College colchicine trial (1970s-80s) for liver fibrosis showed no difference in long-term fibrosis levels or clinical outcomes between treatment and placebo groups Open

Mark's statements about Colorectal / ARM & Hirschsprung 4 statements

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Journal of Pediatric Surgery Article Review: February 2023, BAPS issue

Statement The Centre in Rocklaw has become the referral center for esophageal atresia and long gap esophageal atresia cases from the whole of Poland Open

Statement The Sheffield study represents real life surgical reporting and reflects overall management of Hirschsprung's disease within the UK Open

Statement The Tanzania study used trained carers to direct the method of cleansing, concentrating on areas known to harbor commensal and pathogenic bacteria Open

Statement The Tanzania soap bathing trial was well designed, analyzed in substantial detail, and has implications for low to middle income countries where surgical site infections are a major problem Open

Mark's statements about Esophageal Atresia 20 statements

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Journal of Pediatric Surgery Article Review: February 2023, BAPS issue

Statement The Centre in Rocklaw has become the referral center for esophageal atresia and long gap esophageal atresia cases from the whole of Poland Open

Statement The Sheffield study represents real life surgical reporting and reflects overall management of Hirschsprung's disease within the UK Open

Statement The Tanzania study used trained carers to direct the method of cleansing, concentrating on areas known to harbor commensal and pathogenic bacteria Open

Statement The Tanzania soap bathing trial was well designed, analyzed in substantial detail, and has implications for low to middle income countries where surgical site infections are a major problem Open

Journal of Pediatric Surgery Article Review: Q1 (Jan-Mar) 2024

Quotation Nevertheless, this is definitely a pushback series which extols relatively conventional open surgery, of course. It really, it really does beg the question as to what role and they would say, if any, er lengthening procedures have in those with er with long gaps. Open

Statement The Newcastle series is a pushback series which extols relatively conventional open surgery and begs the question as to what role lengthening procedures have in those with long gaps. Open

Journal of Pediatric Surgery Article Review: February 2022 - BAPS Issue

Quotation My main interest was always to try and work out why babies are sometimes born without kidneys or without normal kidneys or without normal lower urinary tract Open

Statement Dr. Adrian Wolf's research focuses on creating renal organoids with glomerular differentiation from pluripotent stem cells to model human genetic kidney and urinary tract diseases and potentially grow a whole new renal tract. Open

Statement Organoid tissues could potentially be used as replacement therapy instead of formal kidney transplant and could one day be functionally useful in a living patient. Open

Quotation One day these could be functionally useful in actually a living patient Open

Statement The research approach involves identifying the gene that's gone wrong in children born with abnormal kidneys, making stem cells from their blood samples, growing organoids in culture to reproduce the disease in a dish, and looking for druggable targets. Open

Quotation We're trying to look for what we call druggable targets Open

Statement Growing a ureter is difficult, and without the ureter, even if a little kidney could make urine, the urine would have nowhere to go. Open

Quotation Without the ureter, of course, you know, you can have a little kidney and even if it could make urine, the urine would have nowhere to go Open

Statement The very small size of these tissues (a few millimeters across) means that if used as renal replacement therapy, hundreds of them would have to be implanted into a person. Open

Statement These little kidney organoids cannot be connected to a big artery, and the glomeruli in them could never really make much urine because they wouldn't have high pressure, high flow going into them. Open

Quotation We cannot connect these little kidney organoids to a big artery. The glomeruli in them could never really make much urine because they wouldn't have high pressure, high flow going into them Open

Statement ELBT is not universally successful and its role in the management of long gap esophageal atresia will still remain controversial. Open

Quotation It seems to reflect what is happening in the real world and clearly it's not universally successful, and its role in the management of long gap esophageal atresia, I think, will still remain controversial Open

Statement The reimbursement system in the United States is different - physicians are reimbursed on volume - making centralization not an easy thing to do, with a degree of resistance within centers to giving up what is a major part of practice. Open

Mark's statements about Hirschsprung disease 4 statements

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Journal of Pediatric Surgery Article Review: February 2023, BAPS issue

Statement The Centre in Rocklaw has become the referral center for esophageal atresia and long gap esophageal atresia cases from the whole of Poland Open

Statement The Sheffield study represents real life surgical reporting and reflects overall management of Hirschsprung's disease within the UK Open

Statement The Tanzania study used trained carers to direct the method of cleansing, concentrating on areas known to harbor commensal and pathogenic bacteria Open

Statement The Tanzania soap bathing trial was well designed, analyzed in substantial detail, and has implications for low to middle income countries where surgical site infections are a major problem Open

Mark's statements about Intussusception 13 statements

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Journal of Pediatric Surgery Article Review: The Disruption Score

Statement The H-index represents the influence or impact of a particular author, with higher values indicating greater impact Open

Statement Dr. Holcomb's H-index is 51, reflecting extensive publication over his surgical career Open

Statement Dr. Shaw's H-index is 8, which is typical of a fairly average pediatric surgeon Open

Statement If future papers only cite a given paper without citing its references, that paper is considered more disruptive; if they cite both the paper and its references, it is less disruptive and more developmental Open

Quotation The implication is that if those future papers, Are only citing you. Then you're a more disruptive publication. Open

Quotation Well, I wouldn't have a real problem with this one, this is, uh, Michael Gower's paper, um, describing percutaneous endoscopic gastrostomies. Open

Statement The Gauderer-Ponsky paper describing percutaneous endoscopic gastrostomies ranked number 1 on the top 100 most disruptive papers list Open

Statement The number 2 ranked paper was a large series on intussusception Open

Statement The number 3 ranked paper was a large series on fundoplications Open

Quotation But some of them you think, why are they on this list? Open

Statement A case report on fibrous fusion between the liver and lung, cited only 17 times, ranked number 7 on the list Open

Statement Citation scores remain the key method of assessing the impact of a particular paper, and the disruption score does not stand up by comparison to conventional citation metrics Open

Quotation I don't really think it stands up by comparison to the more conventional aspects of how we view the medical literature, the citation scores seems to be still uh the key method of assessing the impact of a particular uh paper. Open

Mark's statements about Long-gap Esophageal Atresia 18 statements

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