Chyme Reinfusion for Small Bowel Double Enterostomies and Enteroatmospheric Fistulas in Adult Patients: A Systematic Review

Abstract

Background High‐output double enterostomies (DESs) and enteroatmospheric fistulas (EAFs) of the small bowel account for substantial patient morbidity and mortality. Management may include parenteral nutrition (PN) and prolonged admissions, at high cost. Reinfusion of chyme into the distal bowel is a proposed therapeutic alternative when the distal DES limb is accessible; however, standardized information on this technique is required. This review aimed to critically assess the literature regarding chyme reinfusion (CR) to define its current status and future directions. Methods A systematic search of medical databases was conducted for articles investigating CR in adults. Articles reporting indications, methods, benefits, technical issues, and complications resulting from CR were reviewed. A narrative synthesis of the retrieved data was undertaken. Results In total, 24 articles reporting 481 cases of CR were identified, although articles were heterogeneous in their structure and reporting. CR was most frequently performed for remediation of high‐output DES and intestinal failure and for proximally located DES. Effluent output collection was commonly manual, with distal reinfusion more commonly automated, and with few dedicated systems. Multiple benefits attributed to CR were reported, encompassing weight gain, cessation of PN, and improvements in liver function. Technical problems included distaste, labor‐intensive methods, reflux of contents, and tube dislodgement. No serious AEs or mortality directly attributable to CR were reported. Conclusions CR appears to be a promising, safe and well‐validated intervention for small bowel DES and EAF. However, more efficient and acceptable methods are required to promote greater adoption of the practice of CR.

Chyme reinfusion nutritional management for enterocutaneous fistula: first international application of a novel pump technique

“…PN meets nutritional demands and reduces gastrointestinal secretions by 30%–50%, thereby minimizing the incidence of dehydration and electrolyte deficiencies [1,2,6]. However, PN carries significant risks including line sepsis and liver dysfunction, and is resource intensive [8,12,13].…”

“…However, PN carries significant risks including line sepsis and liver dysfunction, and is resource intensive [8,12,13].…”

“…Chyme reinfusion (CR) was promoted by Levy et al as extracorporeal reinfusion of the proximal fistula output into the distal bowel [5,9]. Therapeutic effects include weight gain, improved liver function, normalized fluid and electrolyte balance and distal bowel rehabilitation [10], as well as potential cessation of PN and cost effectiveness [2,5,7–9,11,12].…”

Technique Advances in Enteroatmospheric Fistula Isolation After Open Abdomen: A Review and Outlook

“…It was revealed by Mettu et al (27) that fistuloclysis could replace the parenteral nutrition and reduce the cost of nutritional support. For these critically ill surgical patients, fistulaclysis allows early enteral nutrition, which improves prognosis through improvements of intestinal barrier functions and immune states (28,29).…”

Nutritional Management of Patients With Enterocutaneous Fistulas: Practice and Progression

“…The mortality rate of high output EAFs is as high as 30%, while that of low output EAFs is 6% ( 46 ). EAF presenting in an open abdomen is now common and represents substantial challenges in nutritional support.…”