Parenteral nutrition remains a topic of intense research interest. It has now been shown to offer no advantage over, but to be associated with an increased frequency of complications, compared to enteral nutrition in patients with gastrointestinal cancer. Nutritional support administered via an intraportal route, combined with multimodal analgesia, appears to offer certain metabolic and clinical advantages compared with that delivered via systemic veins. Parenteral nutrition, however, does not prevent the decrease in antioxidant capacity seen after major surgery, and feeding lines present an additional risk factor for systemic candidiasis in the intensive care setting. Nonetheless, use of the conventional percutaneous access route is reconfirmed, even in infants, to be a safe technique. Addition of choline to intravenous nutrition admixtures may improve some of the hepatic abnormalities associated with parenteral nutrition, but clodronate has only limited ability to prevent the progression of osteoporosis in patients on long-term treatment. (C) 2003 Lippincott Williams Wilkins.
