Chyme recycling in the management of small bowel double enterostomy in pediatric and neonatal populations: A systematic review

Bhat, Sameer; Cameron, Nelle‐Rose; Sharma, Puja; Bissett, Ian P.; O’Grady, Greg

doi:10.1016/j.clnesp.2020.03.013

Cited by 12 publications

(18 citation statements)

References 38 publications

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“…Clinical benefits included weight gain, PN reduction or cessation, normalization of fluid balance, improvement in liver function tests, and distal gut maturation. [55] Neonates who underwent MFR had a lower chance of an anastomotic leak and quicker progression to full feed after reversal versus controls. However, significant complications associated with MFR have been described including perforation and bleeding.…”

Section: Surgical Aspectsmentioning

confidence: 94%

Short Bowel Syndrome in neonates and early infancy

2023

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Short bowel syndrome (SBS) is the commonest cause of intestinal failure in neonates. SBS results from widespread damage to the small intestine, leading to loss of functional capacity of this organ. This is generally secondary to conditions like necrotizing enterocolitis, gastroschisis, intestinal atresia, and midgut volvulus. The small bowel usually adapts to this damage in due course of time. The clinician's role usually entails the management of parenteral nutrition and the fluid and electrolyte balance to tide over this phase. The management should be initiated as soon as the diagnosis is suspected, especially post-surgical resection of the bowel. This should comprise enteral nutrition, with proactive monitoring and supplementation of electrolytes and micronutrients. Intestinal lengthening procedures like the Serial transverse enteroplasty (STEP), and Longitudinal intestinal lengthening and tailoring (LILT) may be considered in infants, where medical therapy fails to correct the pathology. The intricate nature of the condition warrants a multi-disciplinary approach, involving clinicians, intensivists, and surgeons, which ensures the best neonatal outcomes, in terms of the survival rates in these babies.

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Section: Surgical Aspectsmentioning

confidence: 94%

Short Bowel Syndrome in neonates and early infancy

2023

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“…32 However, evidence about the value of chyme reinfusion for both children and adults is limited, owing to the often-times small cohort, different indications, and various re-infusion techniques and outcomes. 31,33…”

Section: Conservative Managementmentioning

confidence: 99%

Systematic review on management of high‐output enterostomy in children: An urgent call for evidence

Stoop,

van Bodegraven,

ten Haaft

et al. 2023

J. pediatr. gastroenterol. nutr.

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Objectives/BackgroundHigh‐output stoma is one of the most common major morbidities in young children with an enterostomy that could lead to intestinal failure. Management of high‐output enterostomy in children is mostly based on personal experience. This systematic review aims to clarify the evidence‐based therapeutic approach of high‐output enterostomy in children.MethodsA systematic review was performed using Pubmed, Embase (Ovid), and Cochrane Library to identify studies published until March 20, 2023, following the 2020 Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guideline. The study population comprised children (i.e., age <18 years) with high‐output enterostomy (i.e., jejuno‐, ileo‐, and/or colostomy), regardless of underlying aetiology. Interventions comprised any (non)pharmacological and/or surgical treatment. Interventions were compared with each other, placebos, and/or no interventions. Primary outcome was reduction of enterostomy output. Secondary outcomes were morbidity, mortality, quality of life, associated healthcare costs, and adverse events.ResultsThe literature search identified 4278 original articles of which 366 were screened on full text, revealing that none of the articles met the inclusion criteria.ConclusionThis first systematic review on management of high‐output enterostomy in children revealed that any evidence on the primary and secondary outcomes is lacking. There is an urgent need for evidence on conservative treatment strategies including fluid restrictions, dietary advices, oral rehydration solution, chyme re‐infusion, and pharmacological and surgical treatments of high‐output enterostomy in children, aiming to reduce the risk for short‐ and long‐term complications. Till more evidence is available, a systematic and multidisciplinary step‐up approach is needed. Therefore, a therapeutic work‐up is proposed that could guide the care.

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“…CR is very effective in restoring intestinal function, reducing the need for intravenous support by 89% [ 67 ]. CR is also effective in neonatal and pediatric populations, but available data are limited [ 72 ]. A study by Gause et al on mucous fistula refeeding in preterm neonates after bowel resection and small bowel enterostomy demonstrated that, in the inter-operative period, CR patients reached goal enteral feedings and were able to have PN discontinued significantly earlier than patients with an enterostomy only, without creation of a mucous fistula and refeeding efforts.…”

Section: Conservative Treatmentmentioning

confidence: 99%

Surgical Treatment of Short Bowel Syndrome—The Past, the Present and the Future, a Descriptive Review of the Literature

et al. 2022

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Short bowel syndrome (SBS) is a devastating disorder with both short- and long-term implications for patients. Unfortunately, the prevalence of SBS has doubled over the past 40 years. Broadly speaking, the etiology of SBS can be categorized as congenital or secondary, the latter typically due to extensive small bowel resection following diseases of the small intestine, e.g., necrotizing enterocolitis, Hirschsprung’s disease or intestinal atresia. As of yet, no cure exists, thus, conservative treatment, primarily parenteral nutrition (PN), is the first-line therapy. In some cases, weaning from PN is not possible and operative therapy is required. The invention of the longitudinal intestinal lengthening and tailoring (LILT or Bianchi) procedure in 1980 was a major step forward in patient care and spawned further techniques that continue to improve lives for patients with severe SBS (e.g., double barrel enteroplasty, serial transverse enteroplasty, etc.). With this review, we aim to provide an overview of the clinical implications of SBS, common conservative therapies and the development of operative techniques over the past six decades. We also provide a short outlook on the future of operative techniques, specifically with respect to regenerative medicine.

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Chyme recycling in the management of small bowel double enterostomy in pediatric and neonatal populations: A systematic review

Cited by 12 publications

References 38 publications

Short Bowel Syndrome in neonates and early infancy

Short Bowel Syndrome in neonates and early infancy

Systematic review on management of high‐output enterostomy in children: An urgent call for evidence

Surgical Treatment of Short Bowel Syndrome—The Past, the Present and the Future, a Descriptive Review of the Literature

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