Zahid R Pasha, James V Sitzmann, Henry A Pitt.
Cholecystokinin prevents parenteral nutrition induced gall bladder sludge in humans.
J Pak Inst Med Sci Jan ;4(1,2):185-90.

Long term total parenteral nutrition (TPN) induces biliary sludge and gallstone formation. Cholecystectomy is hazardous in these patients due to their underlying medical problems. Therefore, a randomized, double blind controlled study was designed to test the hypothesis that daily administration of cholecystokinin-octapeptide (CCK-OP) prevents biliary sludge formation in humans receiving longterm TPN. Adult patients receiving TPN for greater than 21 consecutive days were eligible. After randomization of IS patients, the study was concluded because statistical significance was achieved. Eight patients received IV saline (placebo), and seven received daily IV CCK-OP (SO ng/kg) over 10 minutes. The groups were similar with respect to age, sex, diagnosis, liver function tests, amylase, total TPN time, and time of study. All patients underwent weekly ultrasound examination. Gall bladder volume and emptying studies in response to study drug were performed after one week. None of the patients receiving CCK-OP developed sludge whereas 63% of placebo patients developed sludge (p < 0.02). Emptying studies showed significant gall bladder contraction in the CCK-OP group but not in the placebo group. These data suggest that daily intravenous CCK-OP prevents TPN-induced gall bladder stasis and sludge. We conclude that CCK-OP should be employed as routine prophylaxis against biliary sludge and gallstone formation in patients receiving long-term TPN.

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