407.3: Chronic Intestinal Failure Due to Short Bowel Syndrome in Adult Patients: 15 Years of Experience in Intestinal Rehabilitation at a Referral Center in Argentina

Abstract

Introduction: Chronic Intestinal Failure (CIF) due to Short Bowel Syndrome (SBS) is a complex disease that requires a multi and interdisciplinary approach in specialized centers. Although Parenteral Nutrition (PN) is the main support, long-time complications could be developed, and, some patients might require intestinal transplantation; but over the years, medical and surgical rehabilitation has become the cornerstone therapy allowing to achieve intestinal sufficiency minimizing the transplant need. Here we aim to assess the clinical and surgical characteristics of patients achieving PN independency by rehabilitation, at a single referral center. Materials and Methods: A retrospective analysis from a prospectively fill data base including CIF/SBS patients was performed. Variables included were SBS etiology, intestinal rehabilitation surgery performed, post-surgical intestinal length, post-surgical anatomy type, time on PN and medical treatment implemented and Kaplan Meier analyses for PN independency and survival was done using SPSS v20.0. Results: From 2006 to 2021, 368 adult patients with intestinal failure attended to our Unit; 264 of them (72%) had CIF and in 187 (71%) SBS, was the leading cause. One hundred and fifteen (62%) underwent AGIRS, and 84 (73%) were able to wean off PN after surgery. The mean post-surgical intestinal length in these patients was 155.3 ± 102.6cm and the post-surgical anatomy was type 1 in 3 patients (4%), type 2 in 22 (26%) and type 3 in 57 (68%). Overall mean time on PN for those patients weaned-off was 1,163 ± 4,488 days. Seventy-one patients (85%) achieve intestinal sufficiency with standard treatment (antisecretory, antimotility drugs) while other 13 patients benefit from using enterohormones. There was a significant difference in rehabilitation according to anatomy type (p= 0.001), intestinal length (p= 0.001) and treatment type (p= 0.001). Figure 1 and 2 show Intestinal rehabilitation according to anatomy type and intestinal length. Overall patient survival at 15 years was 89%. Only 19/368 patients required transplant (7%). Conclusion: CIF/SBS are severe conditions that require a multidisciplinary team. Intestinal rehabilitation through medical-nutritional and surgical strategies have changed the outcome of this pathology. In our unit and, after 15 years of experience, intestinal sufficiency was achieved in patients despite having unfavorable intestinal lengths and anatomy types, becoming the main therapeutic approach, limiting the indications for transplantation.