2018 Volume 54 Issue 1 Pages 75-80
Omegaven® is a fish-oil-based lipid emulsion with high contents of the omega-3 fatty acid. Its efficacy in the treatment of intestinal-failure-associated liver disease (IFALD) has been reported widely. However, the evidence supporting the use of Omegaven® for IFALD is still not convincing; no pharmaceutical approval has been obtained for its use in Japan. In this review, we will discuss the efficacy and complications in two cases of IFALD patients, to whom Omegaven® was administered. The first case was that of a female infant who presented with multiple small intestine atresias. After undergoing massive resection of the small intestine, IFALD was triggered owing to long-term parenteral nutrition. Because of the time spent in seeking approval to use Omegaven®, she was administered with the emulsion later than usual. Her condition deteriorated and she died of hepatorenal failure. The second patient was born with an extremely low birth weight. While being treated, he developed necrotizing enterocolitis. Two stomas were formed on this patient, which led to IFALD. As this was our second case, we were immediately able to administer Omegaven®. Subsequently, Omegaven® contributed to enable his stomas to be closed. The high rate of eicosapentaenoic acid on the phosphorus lipid of the platelet membrane causes bleeding diathesis. In practice, our two patients developed bleeding during treatment. An IFALD patient has hemorrhagic diathesis caused by liver failure. Therefore, it is possible that a complication of bleeding diathesis caused by the omega-3 fatty acid becomes fatal to an IFALD patient. We must know not only the efficacy but also the complications caused by the omega-3 fatty acid.
