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Published on: September 20, 2019
Prevalence of Gallstones Compared in Children With Different Intravenous Lipids
Judith Pichler1, Tom Watson, Kieran McHugh
1*Department of Paediatric Gastroenterology, Great Ormond Street Hospital NHS Trust, London, UK †Department of Paediatric Nephrology and Gastroenterology, University Children's Hospital, University Clinics Vienna, Austria.
Insights
Hepatobiliary complications are common in children receiving long-term parenteral nutrition (PN). Using mixed lipid emulsions is associated with fewer biliary issues compared to pure soya lipid, making it the preferred choice for pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Clinical Nutrition
Background:
- Biliary liver disease in children with intestinal failure on long-term parenteral nutrition (PN) has multiple causes.
- Lipid formulations in PN are a significant risk factor for hepatobiliary complications.
Purpose of the Study:
- To compare the prevalence and outcomes of gallstones and sludge in children receiving different types of intravenous lipids during PN.
- To identify risk factors associated with hepatobiliary abnormalities in this patient population.
Main Methods:
- A retrospective review of liver and biliary tract imaging and clinical data from 71 children (aged 3 months to 17 years) on PN for over 3 months.
- Comparison of hepatobiliary abnormalities based on the types of intravenous lipids administered.
Main Results:
- Hepatobiliary abnormalities, including gallstones and sludge, were detected in a significant proportion of children on PN.
- The newer mixed lipid emulsion was associated with fewer hepatobiliary abnormalities compared to pure soya lipid.
- Predictors for sludge included young age at PN initiation, absence of enteral feeding, and motility disorders with a stoma.
Conclusions:
- Hepatobiliary pathology is a frequent occurrence in pediatric patients requiring long-term PN.
- Mixed lipid emulsions demonstrate a lower incidence of biliary complications and are recommended as the primary lipid formulation for children on PN.
Objective:
The aetiology of biliary liver disease in children with intestinal failure treated with long-term parenteral nutrition (PN) is multifactorial. Risks include the lipid component of PN. The aim of the study was to compare prevalence and outcome of gallstones with different types of intravenous lipids.
Methods:
Liver and biliary tract imaging and relevant clinical details were reviewed in 71 patients (37, 52% boys) treated with PN for >3 months. Types of lipid infused were compared with regard to hepatobiliary abnormalities.
Results:
In total 369 abdominal ultrasounds were performed in 71 patients of age between 3 months and 17 years. Underlying diagnoses were short bowel syndrome in 20 (28%), small intestinal enteropathy in 34 (48%), and motility disorder in 17 (24%). A total of 67 (94%) children had 362/369 scans on lipid-containing PN. Of the total, 15 (21%) patients had gallstones, 8 (11%) had sludge, and both were detected in 7 (10%) children. The gallstones/sludge resolved in 7 patients (10%) and persisted in 10 (13%). In 6 patients, sludge progressed to form discrete gallstones, and in 9 children, gallstones led to biliary duct dilatation. Four (6%) patients underwent cholecystectomy. Fewer children had abnormalities with the newer mixed lipid emulsion (P = 0.005). There was a higher prevalence of sludge (P = 0.01) on pure soya lipid. Predictors for sludge were young age at PN (P = 0.001), lack of enteral feed (P < 0.001), and motility disorder with stoma (P = 0.002).
Conclusions:
Hepatobiliary pathology is common in children on PN. The use of mixed lipid was associated with less biliary complications and should be the first choice of treatment in children.
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