Failure of cholecystokinin-octapeptide to prevent TPN-associated gallstone disease.

Abstract

PURPOSE:

Gallstone formation is a common problem in neonates on prolonged courses of total parenteral nutrition (TPN). The authors hypothesized that the use of cholecystokinin-octapeptide (CCK), given at the time of TPN administration, would prevent gallstone formation in a high-risk group of patients with TPN.

METHODS:

A prospective, randomized, blinded, controlled trial of neonates who were on a prolonged course of TPN for prematurity (25 infants), necrotizing enterocolitis (NEC, 8 infants), or abdominal surgery (5 infants) were selected randomly to receive CCK vs placebo. Patients remained on the study until taking more than 50% of energy enterally. Children were recalled between 2 and 4 years after completing TPN for ultrasonographic examination of their hepatobiliary tree.

RESULTS:

Neonates (38 studied) required a mean (+/-SD) of 33 +/- 16 days of TPN. Cholelithiasis was detected in 4 (10%) infants. Cholecystokinin-octapeptide was not effective in preventing the formation of gallstones (3 stones in infants receiving CCK, P = .51). Diagnosis (P = .56), birth weight (P = .54), gestational age (P = .18), and duration of TPN (P = .53) did not correlate with gallstone formation. To address the management of these stones, all 4 were placed on a prolonged course of ursodeoxycholic acid (mean duration, 11.6 +/- 5.4 months). Two additional infants (not in the original study) with TPN-associated gallstone disease were also given a trial of ursodeoxycholic acid. Serial ultrasounds were performed every 6 months. No patient achieved any degree of stone dissolution. One patient underwent cholecystectomy for symptomatology.

CONCLUSIONS:

Total parenteral nutrition-associated gallstones were detected in 10% of children, and most are nonsymptomatic. Cholecystokinin-octapeptide prophylaxis was not effective in preventing TPN-associated gallstones. In addition, the use of ursodeoxycholic acid did not dissolve gallstones, once identified. Future methods will be needed to address the prevention and treatment of these stones.

• Authors: Susan Tsai, Peter J Strouse, Robert A Drongowski, Saleem Islam, Daniel H Teitelbaum
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 40 Issue 1 Pg. 263-7 (Jan 2005) ISSN: 1531-5037 [Electronic] United States
• PMID: 15868595 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• Cholagogues and Choleretics
• Gastrointestinal Agents
• Ursodeoxycholic Acid
• Sincalide

Topics

• Cholagogues and Choleretics (therapeutic use)
• Double-Blind Method
• Gallstones (drug therapy, etiology, prevention & control)
• Gastrointestinal Agents (therapeutic use)
• Humans
• Infant
• Infant, Newborn
• Parenteral Nutrition, Total (adverse effects)
• Prospective Studies
• Sincalide (therapeutic use)
• Treatment Failure
• Ursodeoxycholic Acid (therapeutic use)