Chyme reinfusion in patients with intestinal failure due to temporary double enterostomy: A 15-year prospective cohort in a referral centre
Open accessAbstract
Background & aims Patients with double temporary enterostomy may suffer from intestinal failure (IF). Parenteral nutrition (PN) is the gold standard treatment until surgical reestablishment of intestinal continuity. Chyme reinfusion (CR) is a technique consisting in an extracorporeal circulation of the chyme. The aims were to determine: i) whether CR could restore intestinal absorption, decrease PN needs, improve nutritional status and plasma liver tests; ii) the feasibility of home CR. Methods From the 232 patients IF consecutively referred for CR from 2000 to 2014, the 212 patients with IF, technical feasibility of CR, and effectively treated by CR, were included. Were collected prospectively before and during CR: daily stomal and fecal outputs, coefficients of nitrogen (CNDA) and fat (CFDA) digestive absorption, weight loss, body mass index (BMI), Nutritional Risk Index (NRI), plasma albumin, citrulline, and liver tests. Results 183 patients had temporary double enterostomy and 29 exposed enterocutaneous fistulas. CR reduced the intestinal output (2444 ± 933 vs 370 ± 457 ml/day, P < 0.001), improved CNDA (46 ± 16 vs 80 ± 14%, P < 0.001) and CFDA (48 ± 25 vs 86 ± 11%, P < 0.001), and normalized plasma citrulline concentration (17.6 ± 8.4 vs 30.3 ± 11.8 μmol/l, P < 0.001). PN was stopped in 126/139 (91%) patients within 2 ± 8 d. Nutritional status improved (P < 0.001): weight (+4.6 ± 8.6%), BMI (+3.8 ± 7.7%), plasma albumin (+6.2 ± 6.1 g/l), and NRI (+10.9 ± 9.5). The proportion of patients with plasma liver tests abnormalities decreased (88 vs 51%, P < 0.01). Home CR was feasible without any serious complications in selected patients. Conclusions CR corrected the intestinal failure by restoring intestinal absorption, allowing PN weaning in 91% of patients. CR contributes to improve nutritional status and to reduce plasma liver tests abnormalities, and is feasible at home.
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Impaired splanchnic perfusion related to shock can potentially be further aggravated by EN administration as digestion represents an extra workload theoretically capable of leading to bowel ischemia or necrosis.
“In fact, impaired splanchnic perfusion related to shock can potentially be further aggravated by EN administration as digestion represents an extra workload theoretically capable of leading to bowel ischemia or necrosis (331).”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [331]
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Zhu, L., Baker, S. S., Gill, C., Liu, W., Alkhouri, R., Baker, R. D., & Gill, S. R. (2013) · Hepatology · doi:10.1002/hep.26093 · Cited by 1,708 · cited 1× · see citing works
“The endoluminal production of alcohol and acetaldehyde in the 390 intestinal lumen and in the hepatocytes could also explain in part the plasma liver tests 391 abnormalities [31,32].”
BackgroundBile acid receptors as targets for drug development
Schaap, F. G., Trauner, M., & Jansen, P. L. M. (2014) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2013.151 · Cited by 696 · see citing works
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ESPEN guideline on clinical nutrition in the intensive care unit.
Singer, P., Blaser, A. R., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., Hiesmayr, M., Mayer, K., Montejo, J. C., Pichard, C., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.08.037 · Cited by 2,904 · see citing works
ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit
Singer, P., Blaser, A. R., Berger, M. M., Calder, P. C., Casaer, M., Hiesmayr, M., Mayer, K., Montejo-Gonzalez, J. C., Pichard, C., Preiser, J.-C., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.07.011 · Cited by 793 · see citing works
- Authors
- Picot, D., Layec, S., Dussaulx, L., Trivin, F., & Thibault, R.
- Affiliations
- Inserm (FR)
- Corresponding author
- Picot, Denis
- Thibault, Ronan
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2017-04
- Volume
- 36
- Issue
- 2
- Pages
- 593-600
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W2343423303
- Cited by
- 61
- References
- 2
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 6 · 2023: 6 · 2022: 7 · 2021: 5 · 2020: 10 · 2019: 6 · 2018: 2 · 2017: 2 · 2016: 1
- FWCI
- 3.83
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion, other-oa)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- intestinal failure, parenteral nutrition weaning, intestinal absorption, plasma citrulline, nutritional status, enterocutaneous fistula, liver function tests, serum albumin, nutritional risk index, weight gain, extracorporeal circulation, home parenteral nutrition
- MeSH terms
- Adult, Aged, Citrulline, Enterostomy, Feasibility Studies, Female, Follow-Up Studies, Gastrointestinal Contents, Humans, Intestinal Absorption, Intestinal Diseases, Intestines, Male, Middle Aged, Nutritional Status, Parenteral Nutrition, Prospective Studies, Referral and Consultation, Serum Albumin, Body Mass Index, Endpoint Determination
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