P1.16: CHYME REINFUSION AS TREATMENT OF TEMPORARY INTESTINAL FAILURE TYPE 2 RELATED TO HIGH-OUTPUT DOUBLE ENTEROSTOMIES OR ENTERO-ATMOSPHERIC FISTULAS.

Abstract

Introduction: Temporary double enterostomy (DES) and entero-atmospheric fistulas (EAF) may lead to a type 2 intestinal failure by short bowel syndrome type I. The reinfusion of chyme (CR) from the afferent small bowel to the efferent ileum (EI) restores the intestinal functions until the surgical reestablishment of continuity (SR). Retrospective observational study of 306 patients with CR hospitalized in our centre for 19 years. Methods: Data from 01/2000 to 12/2018. CR was made with automates and portable pumps with batteries. Height, weight, albumin (Alb), daily intestinal output (IO), nitrogen and lipid absorption (NA, LA), plasma citrulline (Cit) and liver enzymes (ASAT, ALAT, Alcaline phosphatases (AP), γGT were recorded before and during CR. BMI, Nutritional Risk Index (NRI) were calculated. Durations as medians ± IQ, other data as means ± SD. Student’s t- test, χ 2 Fisher’s tests. Results: 185H/121F, 64±15 y. DES 266, EAF 40. CR began 5±8d after admission and was pursued 62±41d until SR, at home for 31% of DES patients. The intestinal function improved: IO (2378±775 ml/d - 325±320), NA (51±18 % - 81±12 %), LA (41±22 % - 87±9%), Cit (17.5±6.9 µmol/l – 32.2±17.4). Nutritional status: BMI 24.9±6.5 – 25.1±5.4, Alb 28.2±5.6 – 33.9±5.0 g/l, patients with NRI<83.5 (68% – 27%).The % of patients with plasma liver tests > 2N: ALAT 26% – 13%, ASAT 28% – 10%, AP 42% – 14%, γGT 78% – 38%.Oral feeding was exclusive (n= 194), with an enteral complement “en Y” in EI (n=75). The intravenous supplementation (IVS) requirements were nutritional (n=161) or hydration alone (n=44). They were stopped in 189/205 cases, 2±8d after the beginning of the RC. (p<0.001 in all results). Conclusion: In cases of high-output DES or EAF, the CR reestablishes the continuity of the bowel, restores its functions and adaptes the downstream small bowel and colon before SR. Some postoperative complications are prevented. Patients are fed with what they eat, their nutritional and liver status improves, IVS are stopped in 92% of the cases, reduced otherwise. CR is feasible at home. CR is much less expensive and avoids complications related to IVS and central venous catheters. This enteral technic was recently recommended by special interest groups of ESPEN and ASPEN.