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

Authors

Susan Tsai, University of Michigan Health System, United States
Peter J. Strouse, University of Michigan Health System, United States
Robert A. Drongowski, University of Michigan Health System, United States
Saleem Islam, University of Michigan Health System, United StatesFollow
Daniel H. Teitelbaum, University of Michigan Health System, United States

Document Type

Article

Department

Paediatric Surgery

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.

Comments

This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

Journal of Pediatric Surgery

Recommended Citation

Tsai, S., Strouse, P. J., Drongowski, R. A., Islam, S., Teitelbaum, D. H. (2005). Failure of cholecystokinin-octapeptide to prevent TPN-associated gallstone disease. Journal of Pediatric Surgery, 40(1), 263-267.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_paediatr/181