Utility of liver biopsy in the evaluation of pediatric total parenteral nutrition cholestasis

Christie L. Buonpane; Guillermo J. Ares; Ethan G. Englert; Irene Helenowski; Valeria C. Cohran; Catherine J. Hunter

doi:10.1016/j.amjsurg.2018.07.019

Utility of liver biopsy in the evaluation of pediatric total parenteral nutrition cholestasis

Christie L. Buonpane, Guillermo J. Ares, Ethan G. Englert, Irene Helenowski, Valeria C. Cohran, Catherine J. Hunter

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

BACKGROUND: Cholestasis is a serious complication of total parenteral nutrition (TPN) in neonates. Liver biopsies may be requested to assess the severity of cholestasis and fibrosis. We hypothesized that liver biopsy would not lead to changes in management or improved patient outcomes.

METHODS: A single institution retrospective review of infants with TPN cholestasis from January 2008 to January 2016.

OUTCOMES: length of stay, complications, change in management and mortality. Statistical analysis was performed using Fisher's exact test.

RESULTS: Twenty-seven out of 95 patients with TPN cholestasis underwent liver biopsy. Liver biopsy was associated with increased utilization or ursodeoxycholic acid (p = 0.001). There were no differences in length of stay (LOS) or mortality. One patient had a complication following anesthesia for liver biopsy, there were no bleeding complications recorded.

CONCLUSIONS: Liver biopsy in patients with TPN cholestasis was associated with an increase in utilization of ursodeoxycholic acid. The effects of this are not fully understood; however, liver biopsy was not associated with improved patient outcomes such as LOS or mortality.

Original language	English (US)
Pages (from-to)	672-677
Number of pages	6
Journal	American Journal of Surgery
Volume	216
Issue number	4
DOIs	https://doi.org/10.1016/j.amjsurg.2018.07.019
State	Published - Oct 1 2018

Keywords

Cholestasis
Liver biopsy
Pediatric
TPN

ASJC Scopus subject areas

Surgery

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10.1016/j.amjsurg.2018.07.019

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title = "Utility of liver biopsy in the evaluation of pediatric total parenteral nutrition cholestasis",

abstract = "BACKGROUND: Cholestasis is a serious complication of total parenteral nutrition (TPN) in neonates. Liver biopsies may be requested to assess the severity of cholestasis and fibrosis. We hypothesized that liver biopsy would not lead to changes in management or improved patient outcomes.METHODS: A single institution retrospective review of infants with TPN cholestasis from January 2008 to January 2016.OUTCOMES: length of stay, complications, change in management and mortality. Statistical analysis was performed using Fisher's exact test.RESULTS: Twenty-seven out of 95 patients with TPN cholestasis underwent liver biopsy. Liver biopsy was associated with increased utilization or ursodeoxycholic acid (p = 0.001). There were no differences in length of stay (LOS) or mortality. One patient had a complication following anesthesia for liver biopsy, there were no bleeding complications recorded.CONCLUSIONS: Liver biopsy in patients with TPN cholestasis was associated with an increase in utilization of ursodeoxycholic acid. The effects of this are not fully understood; however, liver biopsy was not associated with improved patient outcomes such as LOS or mortality.",

keywords = "Cholestasis, Liver biopsy, Pediatric, TPN",

author = "Buonpane, {Christie L.} and Ares, {Guillermo J.} and Englert, {Ethan G.} and Irene Helenowski and Cohran, {Valeria C.} and Hunter, {Catherine J.}",

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AU - Buonpane, Christie L.

AU - Ares, Guillermo J.

AU - Englert, Ethan G.

AU - Helenowski, Irene

AU - Cohran, Valeria C.

AU - Hunter, Catherine J.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - BACKGROUND: Cholestasis is a serious complication of total parenteral nutrition (TPN) in neonates. Liver biopsies may be requested to assess the severity of cholestasis and fibrosis. We hypothesized that liver biopsy would not lead to changes in management or improved patient outcomes.METHODS: A single institution retrospective review of infants with TPN cholestasis from January 2008 to January 2016.OUTCOMES: length of stay, complications, change in management and mortality. Statistical analysis was performed using Fisher's exact test.RESULTS: Twenty-seven out of 95 patients with TPN cholestasis underwent liver biopsy. Liver biopsy was associated with increased utilization or ursodeoxycholic acid (p = 0.001). There were no differences in length of stay (LOS) or mortality. One patient had a complication following anesthesia for liver biopsy, there were no bleeding complications recorded.CONCLUSIONS: Liver biopsy in patients with TPN cholestasis was associated with an increase in utilization of ursodeoxycholic acid. The effects of this are not fully understood; however, liver biopsy was not associated with improved patient outcomes such as LOS or mortality.

AB - BACKGROUND: Cholestasis is a serious complication of total parenteral nutrition (TPN) in neonates. Liver biopsies may be requested to assess the severity of cholestasis and fibrosis. We hypothesized that liver biopsy would not lead to changes in management or improved patient outcomes.METHODS: A single institution retrospective review of infants with TPN cholestasis from January 2008 to January 2016.OUTCOMES: length of stay, complications, change in management and mortality. Statistical analysis was performed using Fisher's exact test.RESULTS: Twenty-seven out of 95 patients with TPN cholestasis underwent liver biopsy. Liver biopsy was associated with increased utilization or ursodeoxycholic acid (p = 0.001). There were no differences in length of stay (LOS) or mortality. One patient had a complication following anesthesia for liver biopsy, there were no bleeding complications recorded.CONCLUSIONS: Liver biopsy in patients with TPN cholestasis was associated with an increase in utilization of ursodeoxycholic acid. The effects of this are not fully understood; however, liver biopsy was not associated with improved patient outcomes such as LOS or mortality.

KW - Cholestasis

KW - Liver biopsy

KW - Pediatric

KW - TPN

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Utility of liver biopsy in the evaluation of pediatric total parenteral nutrition cholestasis

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