[Postoperative continuous or cyclic total parenteral nutrition].
In patients with inflammatory bowel disease treated by total parenteral nutrition (TPN), the incidence of TPN-induced cholestasis may be reduced by discontinuous (cyclic) TPN. In order to test this statement, a prospective trial was carried out in which 21 selected adults requiring at least 12 day postoperative nutrition were randomly allocated to two groups: continuous vs cyclic TPN. The efficiency, evaluated on nitrogen balance and prealbumin levels, was no different. Those patients undergoing cyclic-TPN needed more insulin in the first four postoperative days. The incidence of biological cholestasis was the same in the two groups. This prospective study gave strong evidence against the potential benefit of cyclic rather than continuous TPN in postoperative patients. Nonetheless, additional prospective trials using larger patient populations and greater lengths of TPN are needed to confirm these findings.