Serum Gamma Glutamyl Transpeptidase (GGTP), a useful screening test for diagnosis of pediatric cholestatic liver disorders, may show a progressive fall in patients with high GGTP cholestasis at baseline with failing hepatic functions, leading to erroneous interpretation. So, this study was aimed to check the diagnostic significance of GGTP values in advanced high GGTP pediatric cholestatic liver diseases. Seven prototype cases (4 cases of biliary atresia, 2 cases of progressive familial intrahepatic cholestasis type 3 and 1 case of primary sclerosing cholangitis(with complete workup and adequate follow up) were evaluated in detail. In these cases, serum GGTP levels initially remained high and gradually went down as the disease progressed i.e decompensation of hepatic function occurred. The study thus concluded that serum GGTP levels should not be used in isolation to consider a differential diagnosis of pediatric cholestatic disorders in resource constraint countries and should always be used in conjunction with hepatic synthetic functions and clinical picture to avoid misinterpretation.