Review article: hepatobiliary complications associated with total parenteral nutrition

Angélico, M.; Guardia, P. Della

doi:10.1046/j.1365-2036.2000.014s2054.x

Cited by 72 publications

(48 citation statements)

References 18 publications

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“…Fasting promotes gallbladder hypocontractility due to insufficient secretion of cholecystokinin and may, in part, explain the abdominal surgical patient group preference [8,9] . Other risk factors for sludge formation include TPN, pregnancy and acquired immunodeficiency syndrome [10,11] . The persistent cholestasis of our patient, despite removal of the extrahepatic biliary cast, is explained by the fact that development of cast was extensive and included the small intrahepatic ducts resulting in obstructive cholangiopathy.…”

Section: Discussionmentioning

confidence: 99%

Heterogeneity of endoscopy negative heartburn: Epidemiology and natural history

Katsinelos

Kountouras²,

Chatzimavroudis

et al. 2008

WJG

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A 76-year-old diabetic man underwent cholecystectomy for gangrenous calculous cholecystitis. His postoperative course was complicated by the development of Candida albicans esophagitis necessitating antifungal therapy, and total parenteral nutrition (TPN) for 1 5 d . S e ve n w e e k s a f t e r c h o l e c y s t e c t o my, h e presented with cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated extrahepatic filling defects. Despite endoscopic extraction of a biliary cast, cholestasis remained unchanged. Oral administration of ursodeoxycholic acid (UDCA), 750 mg/d, resulted in normalization of liver function tests. We, therefore, propose for the first time, combined endoscopic plus UDCA treatment for the management of biliary cast syndrome.

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Section: Discussionmentioning

confidence: 99%

Heterogeneity of endoscopy negative heartburn: Epidemiology and natural history

Katsinelos

Kountouras²,

Chatzimavroudis

et al. 2008

WJG

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“…The mortality in our cohort was especially low (7%) compared with similar pediatric groups (16-33%) (Colomb et al, 1992;Angelico and Della Guardia, 2000). In our study, the long duration of TPN favored a selection of patients with digestive etiologies, which have a better survival rate compared with systemic disease (congenital and acquired immune deficiencies, for example).…”

Section: Discussionmentioning

confidence: 63%

“…For this reason, we described precise biochemical and histological hepatic abnormalities. Biochemical impairments were especially frequent in our cohort (57%) compared with the other pediatric studies (15-23%) (Angelico and Della Guardia, 2000;Colomb et al, 2007;Diamanti et al, 2007); Diamanti et al, 2003); despite oral nutrition for all patients of our cohort, which is a wellknown protective factor against PNALD. Again, the double duration of TPN in our cohort compared with previous published studies may explain this difference.…”

Section: Discussionmentioning

confidence: 68%

“…However, a long period of TPN can lead to severe complications. Among them, chronic abnormalities in liver biochemistries are frequent in adult and children, ranging from 15 to 85% (Clarke et al, 1991;Colomb et al, 1992;Messing et al, 1992;Quigley et al, 1993;Angelico and Della Guardia, 2000;Knafelz et al, 2003;Kelly, 2006;Colomb et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of liver complications in children receiving long-term parenteral nutrition

et al. 2011

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Background/Objectives: The hepatic prognosis of long-term home total parenteral nutrition (TPN)-dependent children is poorly documented. The objective was to study outcome data in home TPN-dependent children and to describe precisely their liver biopsies in the attempt to analyze risk factors for biochemical and histological hepatic abnormalities. Subjects/Methods: Medical records of 42 children receiving home TPN for more than 2 years between January 1998 and December 2007 in a single approved home total parenteral center were reviewed. Hepatic biochemical abnormalities were analyzed. Hepatic biopsies were classified by two independent pathologists. Results: Duration of TPN was 7.9 ± 0.8 years (mean ± s.e.m.), with an average age at onset of 1.5 ± 0.5 years. A total of 24 patients (57%) developed biochemical liver abnormalities in an average of 2.9±0.4 years after starting TPN. Risk factors for biochemical abnormalities were younger age at TPN commencement, longer duration of TPN, higher rate of catheter-related infections and higher volume and energy content of TPN. Liver biopsies were carried out in 43% of patients (mean age 3.2±0.9 years). Almost all patients had fibrosis (94%). Risk factors were dependent on each histological abnormality: fibrosis was significantly associated with a shorter length of bowel and a longer duration of TPN; cholestasis correlated with a lower percentage of total parenteral energy intake due to lipids; and steatosis had no risk factor identified. Conclusion: Our study reports a high rate of histological liver abnormalities and analyzes risk factors in children who underwent very long-term home TPN.

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“…29 The study presented here by Spier et al 7 shows a statistically significant effect of the ursodeoxycholic acid (UDCA) treatment on stone prevention post-LT. UDCA prevents sludge formation as a precursor of stones and casts. UDCA helps in targeting the transporters BSEP and multidrug resistance-associated protein 2 to the canalicular membrane via at least two different signaling cascades.…”

Section: Physical and Metabolic Factorsmentioning

confidence: 72%

Bile duct stones and casts after liver transplantation: Different entities but similar prevention strategy?

et al. 2008

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Biliary cast syndrome (BCS), the presence of biliary casts and debris causing biliary obstruction, occurs in 4%-18% of orthotopic liver transplant (OLT) recipients. Potential consequences include cholangitis and graft damage or loss. Limited data exist regarding the etiology and outcomes of BCS. The purpose of this study was to evaluate donor and recipient risk factors and determine the impact of BCS. A retrospective review of 355 OLT cases identified 9 BCS patients (2.5%) diagnosed by cholangiography. Twenty-six matched controls were also identified. The warm ischemic time was significantly longer in BCS patients. Other recipient and donor preoperative and intraoperative characteristics, including the donor risk index, revealed no significant differences. Overall patient survival showed a trend toward worse outcomes at 6, 12, and 18 months and end of follow-up in the BCS group. Overall graft survival was also worse in the BCS group at all time periods, with statistical significance demonstrated at 18 months and end of follow-up. The number of therapeutic biliary procedures and hospital readmissions was significantly higher in the BCS group. Twenty-two percent of the BCS patients required repeat OLT versus none of the control patients. In conclusion, BCS is an uncommon complication of OLT. Except for a longer warm ischemic time, recipient and donor factors did not predict the occurrence of BCS. BCS patients showed a significantly worse graft survival, as well as a trend toward worse patient survival. Given the negative impact of BCS on liver transplant outcomes, further studies appear justified

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Review article: hepatobiliary complications associated with total parenteral nutrition

Cited by 72 publications

References 18 publications

Heterogeneity of endoscopy negative heartburn: Epidemiology and natural history

Heterogeneity of endoscopy negative heartburn: Epidemiology and natural history

Prevalence of liver complications in children receiving long-term parenteral nutrition

Bile duct stones and casts after liver transplantation: Different entities but similar prevention strategy?

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