Prevalence of Gallstones Compared in Children With Different Intravenous Lipids.

Abstract

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.

• Authors: Judith Pichler, Tom Watson, Kieran McHugh, Susan Hill
• Journal: Journal of pediatric gastroenterology and nutrition (J Pediatr Gastroenterol Nutr) Vol. 61 Issue 2 Pg. 253-9 (Aug 2015) ISSN: 1536-4801 [Electronic] United States
• PMID: 25688480 (Publication Type: Journal Article)

Chemical References

• Fat Emulsions, Intravenous

Topics

• Adolescent
• Bile (diagnostic imaging)
• Biliary Tract Diseases (diagnostic imaging, epidemiology)
• Child
• Child, Preschool
• Fat Emulsions, Intravenous (administration & dosage, adverse effects, therapeutic use)
• Female
• Gallstones (diagnostic imaging, epidemiology)
• Humans
• Infant
• Intestinal Diseases (therapy)
• Intestine, Small (pathology)
• Liver Diseases (diagnostic imaging, epidemiology)
• Male
• Parenteral Nutrition (adverse effects, methods)
• Short Bowel Syndrome (therapy)
• Ultrasonography