Percutaneous cholangiography for the treatment of parenteral nutrition–associated cholestasis in surgical neonates: preliminary experience

• Published in: Journal of pediatric surgery 2007-11, Vol.42 (11), p.1913-1918
• Main Authors: Wales, Paul W, Brindle, Mary, Sauer, Carolien J.E, Patel, Seema, de Silva, Nicole, Chait, Peter
• Format: Article
• Language: English
• Subjects: Case-Control Studies; Cholangiopancreatography, Endoscopic Retrograde - methods; Cholestasis - diagnostic imaging; Cholestasis - etiology; Cholestasis - surgery; Female; Follow-Up Studies; Humans; Infant, Newborn; Male; Minimally Invasive Surgical Procedures - methods; Parenteral Nutrition - adverse effects; Pediatrics; Probability; Reference Values; Retrospective Studies; Risk Assessment; Severity of Illness Index; Surgery; Treatment Outcome
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2007.07.022

Abstract Objective Parenteral nutrition–associated cholestasis (PNAC) occurs in up to 60% of surgical neonates with intestinal failure, and 10% will develop end-stage liver failure. Our aim was to evaluate the effectiveness of percutaneous transhepatic transcholecystic cholangiography (PTTC) in the treatment of PNAC in surgical neonates. Methods A retrospective double cohort study of surgical neonates with PNAC was conducted. Patients with PNAC who received PTTC were compared to controls matched by gestational age, birth weight, sex, and parenteral nutrition duration. Percutaneous transhepatic transcholecystic cholangiography was performed under general anesthesia with ultrasound guidance. Analysis was performed using paired Student's t test and McNemar χ2 test. Results Nine PTTC patients and 9 controls were similar in mean age (35.5 ± 3.1 vs 35.6 ± 4.2 weeks, P = .85), birth weight (2531 ± 879 vs 2692 ± 1052 g, P = .28), sex (all males), and parenteral nutrition duration (51.2 ± 29.8 vs 53.3 ± 33.3 days, P = .74). Percutaneous transhepatic transcholecystic cholangiography was performed in 9 patients at mean corrected age of 5.5 ± 3.4 weeks and weight of 3621 ± 546 g. All control patients and 8 (88.9%) of 9 PTTC patients had eventual resolution of hyperbilirubinemia. Percutaneous transhepatic transcholecystic cholangiography patients experienced a more rapid rate of resolution of their cholestasis, and the mean time to resolution of conjugated bilirubin was less in the PTTC group (8.5 ± 3.2 vs 18.5 ± 7.6 weeks, P = .02). Conclusion Therapeutic PTTC results in a 50% reduction in the time to PNAC resolution. Percutaneous transhepatic transcholecystic cholangiography may have a role as active therapy to slow progression of PNAC in surgical neonates with intestinal failure.