Chyme reinfusion in patients with intestinal failure due to temporary double enterostomy: A 15-year prospective cohort in a referral centre

Picot, D.; Layec, S.; Dussaulx, L.; Trivin, F.; Thibault, Ronan

doi:10.1016/j.clnu.2016.04.020

Cited by 40 publications

(73 citation statements)

References 29 publications

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“…In adult patients, CR could restore intestinal absorptive capacities [4,7]. This could allow PN discontinuation a few days after its initiation [4,5], and the improvement of frequently observed liver tests abnormalities [4]. Plasma liver tests improvement seems greater in patients treated by enteroclysis coupled with CR than by enteroclysis alone [6].…”

Section: Clinical Benefits Of Cr and Enteroclysismentioning

confidence: 99%

“…These studies are monocentric case series, having included only a low number of patients, and did not report post-SIRC clinical outcomes. In adult patients, CR could restore intestinal absorptive capacities [4,7]. This could allow PN discontinuation a few days after its initiation [4,5], and the improvement of frequently observed liver tests abnormalities [4].…”

Section: Clinical Benefits Of Cr and Enteroclysismentioning

confidence: 99%

“…Only one [4] was published within 18 months and none were prospective randomized controlled trials. These studies are monocentric case series, having included only a low number of patients, and did not report post-SIRC clinical outcomes.…”

Section: Clinical Benefits Of Cr and Enteroclysismentioning

confidence: 99%

“…CR [4] (or re-feeding enteroclysis [2,5] or succus entericus reinfusion [8,9]) is an EN technique which artificially re-establishes the small bowel continuity by an extra-corporeal circuit of the chyme and mimics the definitive gastro-intestinal function; the chyme, composed of digestive secretions and nutrients from oral food and/or tube feeding, is collected from the afferent small bowel, and reinfused via the enterostomy or the ECF into the efferent diverted small bowel segment. CR could be, at best, in our experience, continuous, through a portable or not automated pump, or, as reported by others [5], sequential by manual chyme decanting.…”

Section: Definitionsmentioning

confidence: 99%

“…Therefore, the availabilities of low cost, safer, and easy-to-use nutrition support techniques could be of high added value in these type 2 IF patients. Chyme reinfusion (CR) [4][5][6][7][8][9] and enteroclysis [5,6,10] could be these techniques.…”

Section: Introductionmentioning

confidence: 99%

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Chyme reinfusion or enteroclysis in nutrition of patients with temporary double enterostomy or enterocutaneous fistula

Thibault

Picot

2016

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Section: Clinical Benefits Of Cr and Enteroclysismentioning

confidence: 99%

Section: Clinical Benefits Of Cr and Enteroclysismentioning

confidence: 99%

Section: Clinical Benefits Of Cr and Enteroclysismentioning

confidence: 99%

Section: Definitionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Chyme reinfusion or enteroclysis in nutrition of patients with temporary double enterostomy or enterocutaneous fistula

Thibault

Picot

2016

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Novel chyme reinfusion device for gastrointestinal fistulas and stomas: feasibility study

Sharma¹,

Davidson²,

Davidson³

et al. 2020

British Journal of Surgery

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Background High-output enterostomies and enteroatmospheric fistulas are common causes of intestinal failure, and may necessitate parenteral nutrition and prolonged hospital stay. Reinfusing lost chyme into the distal gut is known to be beneficial, but implementation has been limited because manual reinfusion is unpleasant and labour-intensive, and no devices are available. A new device is presented for reinfusing chyme easily and efficiently, with first-in-human data. Methods The device comprises a compact centrifugal pump that fits inside a standard stoma appliance. The pump is connected to an intestinal feeding tube inserted into the distal intestinal limb. The pump is activated across the appliance by magnetic coupling to a hand-held driver unit, effecting intermittent bolus reinfusion while avoiding effluent contact. Safety, technical and clinical factors were evaluated. Results Following microbiological safety testing, the device was evaluated in ten patients (median duration of installation 39·5 days; total 740 days). Indications included remediation of high-output losses (8 patients), dependency on parenteral nutrition (5), and gut rehabilitation before surgery (10). Reinfusion was well tolerated with use of regular boluses of approximately 200 ml, and no device-related serious adverse events occurred. Clinical benefits included resumption of oral diet, cessation of parenteral nutrition (4 of 5 patients), correction of electrolytes and liver enzymes, and hospital discharge (6 of 10). Of seven patients with intestinal continuity restored, one experienced postoperative ileus. Conclusion A novel chyme reinfusion device was developed and found to be safe, demonstrating potential benefits in remediating high-output losses, improving fluid and electrolyte balance, weaning off parenteral nutrition and improving surgical recovery. Pivotal trials and regulatory approvals are now in process.

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Chyme Reinfusion Restores the Regulatory Bile Salt–FGF19 Axis in Patients With Intestinal Failure

et al. 2021

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Automated chyme reinfusion (CR) in intestinal failure (IF) patients with a temporary double enterostomy (TDE) restores intestinal function and protects against liver injury, but the mechanisms are incompletely understood.The aim was to investigate whether beneficial effects of CR relate to functional recovery of enterohepatic signaling via the bile salt-FGF19 axis. Blood samples were collected from 12 patients, 3 days before, at start, and 1, 3, 5 and 7 weeks after CR initiation. Plasma FGF19, total bile salts (TBS), C4 (marker of bile salt synthesis), citrulline (CIT), bile salt composition, liver tests and nutritional risk indices were determined. Paired small bowel biopsies prior to CR and after 21 days were taken and genes related to bile salt homeostasis and enterocyte function were assessed. CR induced an increase in plasma FGF19 and decreased C4 levels, indicating restored regulation of bile salt synthesis via endocrine FGF19 action. TBS remained unaltered during CR. Intestinal FXR was upregulated after 21 days of CR. Secondary and deconjugated bile salt fractions were increased after CR, reflecting restored microbial metabolism of host bile salts. Furthermore, CIT and albumin levels were gradually rising after CR, while abnormal serum liver tests normalized after CR, indicating restored intestinal function, improved nutritional status and amelioration of liver injury. CR increased gene transcripts related to enterocyte number, carbohydrate handling and bile salt homeostasis. Finally, the reciprocal FGF19/C4 response after 7 days, predicted the plasma CIT time course. CONCLUSIONS: CR in IF-TDE patients restored bile salt-FGF19 signaling and improved gut-liver function. Beneficial effects of CR are partly mediated by recovery of the bile salt-FGF19 axis and subsequent homeostatic regulation of bile salt synthesis.

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Chyme reinfusion in patients with intestinal failure due to temporary double enterostomy: A 15-year prospective cohort in a referral centre

Abstract: 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.

Cited by 40 publications

References 29 publications

Chyme reinfusion or enteroclysis in nutrition of patients with temporary double enterostomy or enterocutaneous fistula

Chyme reinfusion or enteroclysis in nutrition of patients with temporary double enterostomy or enterocutaneous fistula

Novel chyme reinfusion device for gastrointestinal fistulas and stomas: feasibility study

Chyme Reinfusion Restores the Regulatory Bile Salt–FGF19 Axis in Patients With Intestinal Failure

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