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Increased risk of gallstones in children receiving total parenteral nutrition
Insights
Children on long-term total parenteral nutrition (TPN) with ileal disorders face a high risk of gallstones. This study highlights the increased prevalence of cholelithiasis in these patients, emphasizing the need for monitoring.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Surgical Nutrition
Background:
- Gallstone formation is a known complication of long-term parenteral nutrition.
- Ileal disorders and resections are associated with an increased risk of gallstones.
Purpose of the Study:
- To prospectively evaluate the prevalence of gallstones in children receiving long-term total parenteral nutrition (TPN).
- To identify risk factors for gallstone formation in this pediatric population.
Main Methods:
- Prospective evaluation of 21 children on long-term TPN.
- Ultrasonography used to detect gallstones (cholelithiasis).
- Analysis of gallstone prevalence based on ileal status (disorders or resection).
Main Results:
- Nine out of 21 children (43%) developed gallstones.
- Gallstones were exclusively found in children with ileal disorders or previous resection.
- In this subgroup, gallstone prevalence was 64%, nearly double that of adults without TPN.
Conclusions:
- Prolonged TPN significantly increases gallstone risk in children with pre-existing ileal conditions.
- Periodic ultrasonography is recommended for monitoring high-risk pediatric patients during and after TPN therapy.
Abstract:
Twenty-one children receiving long-term total parenteral nutrition were prospectively evaluated for the presence of gallstones. Using ultrasonography, nine children (43%) were found to have cholelithiasis, and five have since undergone cholecystectomy. Only children with ileal disorders or previous resection developed stones. In the select group of patients with ileal disorders or previous resection, the prevalence of stones was 64%, nearly twice that which has been observed in similarly defined adults not receiving total parenteral nutrition. Data from this study suggest that the prolonged administration of parenteral nutrition significantly enhances the risk of gallstone formation already imposed by a previous ileal resection or disorder. Periodic ultrasonograms provide a safe and accurate means of monitoring high-risk patients during and after prolonged total parenteral nutrition therapy.