PubMed · 17185092
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Martin L Freeman. 2007. Cannulation techniques for ERCP: one size does not fit all.. https://doi.org/10.1016/j.gie.2006.07.038
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BACKGROUND/AIMS: Total parenteral nutrition (TPN) has proven a tremendous advance in all disciplines in medicine but itself introduces a spectrum of possible complications related to both the parenteral nutritional solution as well as the technique of intravenous delivery. Our aim is to review the specific complications of TPN. MATERIALS AND METHODS: This article presents a critical literature review of relevant topics in TPN-related complications-metabolic, infections, and nutrition related. RESULTS: Special emphasis focuses on complications of TPN arising from thrombosis or infectious sequelae related to the central venous catheterization and metabolic complications involving the kidneys, bones, liver, and biliary tract. CONCLUSIONS: Awareness and surveillance of TPN-related complications can prevent, potentially, some of these complications related to parenteral nutritional support.
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BACKGROUND: Surgical bypass and endoscopic stents are available for palliative bypass of malignant distal biliary obstruction. AIM: Comparison of reported outcomes in randomized controlled trials (RCTs) which included surgery, endoscopic plastic stents or endoscopic metal stents in palliative relief of malignant distal biliary obstruction. METHODS: Systematic review and meta-analysis of published literature and conference proceedings review to June 2006. RESULTS: We found 24 studies, containing 2436 patients, which met our inclusion criteria. Endoscopic stenting with plastic stents (three studies) is associated with a lower risk of complications (RR 0.60, 95% CI 0.45-0.81), but a higher risk of recurrent biliary obstruction (RR 18.59, 95% CI 5.33 -64.86) than traditional surgical bypass. Self-expanding metal stents (seven studies) are associated with a significantly reduced risk of recurrent biliary obstruction at 4 months (RR 0.44, 95% CI 0.3, 0.63), or prior to death or end of study (RR 0.52, 95% CI 0.39-0.69), but are not superior to plastic stents in terms of technical success, therapeutic success, mortality or complications. Cost-effectiveness outcomes were not suitable for meta-analysis. No other plastic stent designs have been demonstrated to be superior to polyethylene stents (12 studies). CONCLUSIONS: Endoscopic metal stents are the intervention of choice in patients with malignant distal biliary obstruction, producing similar outcomes to plastic stents, but with improved patency rates.