Intestinal Failure Management at the Cleveland Clinic

Abstract

The Cleveland Clinic institutional guidelines for the management of intestinal failure, including long-term or home parenteral nutrition and related complications, intestinal rehabilitation, and small bowel transplantation, were reviewed. PubMed was searched for relevant articles. The search was performed in November 2008; keywords used were home parenteral nutrition, short bowel syndrome, intestinal rehabilitation, and small-bowel transplantation. Randomized, prospective, observational, retrospective reviews and case report articles that contained relevant data for long-term parenteral nutrition, intestinal rehabilitation, and intestinal transplantation were selected. Researchers reviewed 67 selected articles that met our inclusion criteria. Our institution data registries for intestinal rehabilitation and home parenteral nutrition were also reviewed for relevant data. The survival of tens of thousands of children and adults with complicated gastrointestinal problems has been possible because of parenteral nutrition. In selected patients, a program of intestinal rehabilitation may avoid the need for long-term parenteral nutrition.

Current status of intestinal and multivisceral transplantation

“…In the adult population, mesenteric vascular thrombosis and inflammatory bowel disease are the most common causes of IF in addition to radiation enteritis, desmoid tumors and trauma [9]. IF can also result from short bowel syndrome (SBS) defined as < 200 cm of residual small intestine due to multiple resections or single resection of significant bowel length [10]. Despite these diverse etiologies, the majority of patients with decompensated IF are dependent on PN to maintain fluid, electrolyte and nutritional homeostasis [10].…”

“…IF can also result from short bowel syndrome (SBS) defined as < 200 cm of residual small intestine due to multiple resections or single resection of significant bowel length [10]. Despite these diverse etiologies, the majority of patients with decompensated IF are dependent on PN to maintain fluid, electrolyte and nutritional homeostasis [10]. …”

“…Other complications of PN include central venous access thrombosis, metabolic bone disease, fluid overload and electrolyte imbalances [10]. One study of 124 adult SBS patients reported survival and PN-dependence probabilities of 86% and 49% and 75% and 45% at 2 and 5 years, respectively [35].…”

Current Status of Intestinal Failure and Intestinal Transplantation

“…Oral administration of ursodeoxycholic acid may improve bile flow and reduce gall bladder stasis, although there is little data to suggest that prophylactic use prevents the onset of PNLD [28]. All patients using long-term parenteral nutrition are at risk for metabolic bone disease (osteoporosis and osteomalacia) and should have a dual-energy x-ray absorptiometry scan performed in their first year [29].…”

Nutrición parenteral domiciliaria pediátrica

“…Al final del estudio, el 54% de los pacientes estaban libres de NP y la mortalidad global fue del 16%, relacionada con la enfermedad primaria, hepatopatía y sepsis. Resultados similares se han observado en otras series más cortas, tanto europeas (3-5) como norteamericanas (6)(7)(8).…”