title: Incidence, risk factors, and complications of cholelithiasis in patients with home parenteral nutrition.
abstract: BACKGROUND
  Previous studies showed high prevalence rates of cholelithiasis in patients with home parenteral nutrition (HPN). Our aim was to determine, in an HPN population, the incidence and risk factors for gallstones and sludge and their complications.
  
  
  METHODS
  Retrospective chart review was conducted in a tertiary care center. One hundred fifty-three consecutive patients who received HPN for longer than 2 months (range 2 to 204 months; median 15 months) between 1985 and 1997 were followed with ultrasonography. Kaplan-Meier curves and log-rank tests were calculated to assess risk factors for gallbladder lithiasis and complications.
  
  
  RESULTS
  Thirty-four patients (22%) underwent cholecystectomy before HPN. Of the 119 remaining patients with gallbladder in situ, cholelithiasis appeared during HPN in 45 (38%). The probability of cholelithiasis developing during HPN was estimated to be 6.2%, 21.2%, and 38.7% at 6, 12, and 24 months, respectively. Biliary complications developed in eight patients (7%) during followup. Therapy consisted of endoscopic sphincterotomy (three patients) or operation (five patients) with uncomplicated outcomes except for one patient; no death was observed. Incidence rates of biliary complication during HPN were estimated to be 0.0%, 4.7%, and 10.1% at 6, 12, and 24 months, respectively. Nil or negligible ingesta was the only factor notably associated with incidence of cholelithiasis (p < 0.01) or biliary complications (p < 0.01).
  
  
  CONCLUSIONS
  This first incidence study shows a high rate of cholelithiasis and a low rate of complications during HPN. Both events were notably related to nil or negligible ingesta.
authors.affiliation: Département de Pathologie Digestive, Hôpital Lariboisière, Paris, France. xavier.dray@lrb.aphp.fr
authors.forename: Xavier
authors.initials: X
authors.lastname: Dray
authors.forename: Francisca
authors.initials: F
authors.lastname: Joly
authors.forename: Didier
authors.initials: D
authors.lastname: Reijasse
authors.forename: Alain
authors.initials: A
authors.lastname: Attar
authors.forename: Arnaud
authors.initials: A
authors.lastname: Alves
authors.forename: Yves
authors.initials: Y
authors.lastname: Panis
authors.forename: Patrice
authors.initials: P
authors.lastname: Valleur
authors.forename: Bernard
authors.initials: B
authors.lastname: Messing
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D002764:Cholecystitis / Q000453:epidemiology / Q000209:etiology*; D002769:Cholelithiasis / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography