Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
권호 표지
DOI QR코드

DOI QR Code

A Multicenter Pilot Study of Biliary Atresia Screening Using Digital Stool Color Imaging

  • Received : 2023.09.25
  • Accepted : 2024.03.15
  • Published : 2024.05.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The presence of alcoholic stool in biliary atresia (BA) patients is the basis of a stool color card (SCC), a screening tool that has led to more patients receiving Kasai portoenterostomy earlier. This study aimed to evaluate the color image processing of stool images captured using smartphones. We propose that measuring digital color parameters is a more objective method for identifying BA stools and may improve the sensitivity of BA screening. Methods: A prospective study was conducted in five hospitals in Thailand between October 1, 2020, and December 31, 2021. Stools from infants presenting with jaundice, acholic stool, or dark-colored urine were photographed. Digital image color analysis was performed, and software was developed based on the color on the original SCC. Sensitivity and specificity for predicting BA stools were compared between the SCC and the software. Results: Of 33 infants eligible for data collection, 19 were diagnosed with BA. Saturation and blue were two potential digital color parameters used to differentiate BA stools. The receiver operating characteristic curve was used to determine the optimum cutoff point of both values, and when saturation ≤56 or blue ≥61 was set as a threshold for detecting BA stool, high accuracy was achieved at 81.8% and 78.8%, respectively. Conclusion: Digital image processing is a promising technology. With appropriate cutoff values of saturation in hue, saturation, value and blue in red, green, blue color models, BA stools can be identified, and equivocal-colored stools of non-BA patients can be differentiated with acceptable accuracy in infants presenting with jaundice.

Keywords

Acknowledgement

The authors would like to thank Dr. Korakot Niruttiwat for her contribution in data collection and Dr. Jarruphong Noitumyae for his assistance in the statistical processing of data. We would also like to express our gratitude to Dr. Rangsan Niramis for his professional advice and language polishing in the preparation of the manuscript.

References

  1. Gesprasert G, Chongsrisawat V, Tantemsapya N, Thirapattaraphan C, Nonthasoot B, Tovikkai C, et al. The first report of pediatric liver transplantation in Thailand from the Thai liver transplant registry. Transplantation 2020;104 (Suppl 3):S536.
  2. Anderson CD, Turmelle YP, Lowell JA, Nadler M, Millis M, Anand R, et al. The effect of recipient-specific surgical issues on outcome of liver transplantation in biliary atresia. Am J Transplant 2008;8:1197-204.
  3. Howard ER, MacLean G, Nio M, Donaldson N, Singer J, Ohi R. Survival patterns in biliary atresia and comparison of quality of life of long-term survivors in Japan and England. J Pediatr Surg 2001;36:892-7.
  4. Ohi R, Nio M, Chiba T, Endo N, Goto M, Ibrahim M. Long-term follow-up after surgery for patients with biliary atresia. J Pediatr Surg 1990;25:442-5.
  5. Redkar R, Karkera PJ, Raj V, Bangar A, Hathiramani V, Krishnan J. Outcome of biliary atresia after Kasai's portoenterostomy: a 15-year experience. Indian Pediatr 2017;54:291-4.
  6. Matsui A. Screening for biliary atresia. Pediatr Surg Int 2017;33:1305-13.
  7. Matsui A, Sasakia N, Arakawa Y, Ishikawa T, Momoya T, Kasano Y, et al. Neonatal mass screening for biliary atresia: a pilot study in Tochigi Prefecture, Japan. Screening 1993;2:201-9.
  8. Yang MC, Chang MH, Chiu SN, Peng SF, Wu JF, Ni YH, et al. Implication of early-onset biliary atresia and extrahepatic congenital anomalies. Pediatr Int 2010;52:569-72.
  9. Tseng JJ, Lai MS, Lin MC, Fu YC. Stool color card screening for biliary atresia. Pediatrics 2011;128:e1209-15.
  10. Gu YH, Yokoyama K, Mizuta K, Tsuchioka T, Kudo T, Sasaki H, et al. Stool color card screening for early detection of biliary atresia and long-term native liver survival: a 19-year cohort study in Japan. J Pediatr 2015;166:897-902.e1.
  11. Watanatittan S, Rattanasuwan T, Niramis R, Buranakitjaroen V, Anuntkosol M. Diagnostic problems in infantile cholestatic jaundice. Thai J Surg 1998;19:45-50.
  12. Hoshino E, Hayashi K, Suzuki M, Obatake M, Urayama KY, Nakano S, et al. An iPhone application using a novel stool color detection algorithm for biliary atresia screening. Pediatr Surg Int 2017;33:1115-21.
  13. Franciscovich A, Vaidya D, Doyle J, Bolinger J, Capdevila M, Rice M, et al. PoopMD, a mobile health application, accurately identifies infant acholic stools. PLoS One 2015;10:e0132270.
  14. Shen Z, Zheng S, Dong R, Chen G. Saturation of stool color in HSV color model is a promising objective parameter for screening biliary atresia. J Pediatr Surg 2016;51:2091-4.
  15. Noitumyae J, Laorwong S, Anantkosol M, Niramis R. [Biliary atresia in infancy: an analysis of diagnosis, prognostic factors and outcomes of treatment]. J Dep Med Serv 2018;43:66-72. Thai.