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Does total parenteral nutrition induce gallbladder sludge formation and lithiasis?

B Messing, C Bories, F Kunstlinger

Gastroenterology

|May 1, 1983

Summary

Total parenteral nutrition (TPN) can lead to gallbladder sludge and gallstones due to bowel rest and bile stasis. Palliating gallbladder stasis is recommended for TPN exceeding one month to prevent gallstone formation.

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Area of Science:

Gastroenterology
Hepatology
Biliary Medicine

Background:

Total parenteral nutrition (TPN) involves intravenous feeding, bypassing the gastrointestinal tract.
Bowel rest and bile stasis are potential side effects of TPN.
The impact of TPN on gallbladder health, specifically sludge and lithiasis formation, requires thorough investigation.

Purpose of the Study:

To determine the prevalence of gallbladder sludge and gallstones in patients undergoing TPN.
To evaluate the temporal relationship between TPN duration and the development of biliary abnormalities.
To assess the reversibility of TPN-induced gallbladder sludge upon reintroduction of oral feeding.

Main Methods:

Serial biliary ultrasonographic studies were conducted on 23 adult gastroenterological patients receiving TPN.
Patients were monitored during and after TPN periods, with initial and follow-up sonograms.
Bile analysis was performed on patients who developed complications.

Main Results:

Gallbladder sludge prevalence increased with TPN duration, reaching 100% in patients treated for over 6 weeks.
Gallstone formation occurred in 6 of 14 patients with sludge, with some requiring cholecystectomy.
Sludge positivity significantly decreased after oral refeeding, resolving by the fourth week.

Conclusions:

Bowel rest and bile stasis during TPN are strongly associated with the development of gallbladder sludge.
TPN-induced sludge can progress to gallstone formation (cholelithiasis).
Interventions to palliate gallbladder stasis are advised for TPN exceeding one month to prevent gallstone complications.