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

Abstract

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.

Evaluating the Efficacy and Safety of Neonatal Chyme Reinfusion Therapy: A Feasibility Study using a Novel Medical Device

“…This study has introduced a novel device ('The Insides Neo') to enable efficient and safe CRT in neonates who have double barrel enterostomy. The device was designed to resolve several limitations of chyme reinfusion identified in previous systematic reviews [11,12], and was manufactured to medical device standards to enable a straightforward and standardized CRT technique. The device was validated within a NICU setting to be safe and effective, and with improved nursing workflows.…”

“…The device needed to address the issues outlined above, to create a safe and effective tool to perform chyme reinfusion to improve patient outcomes and nursing workflows. Device design references were sourced from literature, empirical experience, and feedback from clinicians on prototypes [11,12].…”

“…The device design thus overcomes several limitations that have been identified with performing manual CRT with neonates [11,12]. The Insides Neo is easy to assemble and fits with a widely available ostomy appliance, so no modification to the ostomy appliance is required.…”

“…Severe adverse events have been rare but have included intestinal perforation and haemorrhage [11]. Stoop et al recently concluded in a systematic review limited robust evidence for prescribing pediatric CRT, due to small study numbers and varied administration of the therapy [12]. This lack of uniformity also creates practical challenges for the health care professionals, most of whom do not consider the current practices user-friendly.…”