Ronan Thibault1, Denis Picot. 1. aNutrition Unit, Department of Endocrinology, Diabetology and Nutrition, Home Parenteral Nutrition Centre, CHU Rennes, Université de Rennes 1, INSERM U991 bDepartment of Nutritional and Digestive Rehabilitation, Clinique Saint Yves, Rennes, France.
Abstract
PURPOSE OF REVIEW: Patients with double temporary enterostomy or enterocutaneous fistula may suffer from intestinal failure. Parenteral nutrition is the gold standard treatment until surgical re-establishment of intestinal continuity, but serious complications may arise. Chyme reinfusion or enteroclysis are indicated. RECENT FINDINGS:Chyme reinfusion corrects the intestinal failure by restoring intestinal absorption, allowing parenteral nutrition weaning in 91% of patients. Chyme reinfusion contributes to improve nutritional status and reduce plasma liver test abnormalities. Chyme reinfusion is feasible at home without any serious complications in selected patients. Mechanisms underlying chyme reinfusion effectiveness on intestinal function, such as restoration of ileal brake, are suggested but most remain to be demonstrated. When the downstream small bowel is exposed, enteroclysis of enteral nutrition or hydration could be helpful to reduce parenteral nutrition needs, or in case of insufficient food intake during chyme reinfusion. SUMMARY:Chyme reinfusion or enteroclysis are less expensive, well tolerated, and easy-to-use nutrition support techniques, which may allow reducing parenteral nutrition-related healthcare costs. The latter remains to be demonstrated in the setting of a prospective randomized controlled trial. This review may contribute to improve the awareness of intensivists, digestive surgeons, and gastroenterologists involved in intestinal failure management to spread the use of chyme reinfusion or enteroclysis.
RCT Entities:
PURPOSE OF REVIEW: Patients with double temporary enterostomy or enterocutaneous fistula may suffer from intestinal failure. Parenteral nutrition is the gold standard treatment until surgical re-establishment of intestinal continuity, but serious complications may arise. Chyme reinfusion or enteroclysis are indicated. RECENT FINDINGS: Chyme reinfusion corrects the intestinal failure by restoring intestinal absorption, allowing parenteral nutrition weaning in 91% of patients. Chyme reinfusion contributes to improve nutritional status and reduce plasma liver test abnormalities. Chyme reinfusion is feasible at home without any serious complications in selected patients. Mechanisms underlying chyme reinfusion effectiveness on intestinal function, such as restoration of ileal brake, are suggested but most remain to be demonstrated. When the downstream small bowel is exposed, enteroclysis of enteral nutrition or hydration could be helpful to reduce parenteral nutrition needs, or in case of insufficient food intake during chyme reinfusion. SUMMARY: Chyme reinfusion or enteroclysis are less expensive, well tolerated, and easy-to-use nutrition support techniques, which may allow reducing parenteral nutrition-related healthcare costs. The latter remains to be demonstrated in the setting of a prospective randomized controlled trial. This review may contribute to improve the awareness of intensivists, digestive surgeons, and gastroenterologists involved in intestinal failure management to spread the use of chyme reinfusion or enteroclysis.
Authors: Stella Maye Dilke; Laura Gould; Mark Yao; Maria Souvatzi; Adam Stearns; Ana Ignjatovic-Wilson; Phil Tozer; Carolynne J Vaizey Journal: Frontline Gastroenterol Date: 2020-08-18