Incidence, risk factors, and complications of cholelithiasis in patients with home parenteral nutrition.
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.
Dray
Xavier
X
Département de Pathologie Digestive, Hôpital Lariboisière, Paris, France. xavier.dray@lrb.aphp.fr
Joly
Francisca
F
Reijasse
Didier
D
Attar
Alain
A
Alves
Arnaud
A
Panis
Yves
Y
Valleur
Patrice
P
Messing
Bernard
B
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