P3.49: GLP-2 therapy for patients with short gut syndrome and intestinal insufficiency: A single center experience with future considerations

Abstract

Introduction: The field of gut rehabilitation has recently evolved to restore nutritional autonomy without the need for home parenteral nutrition (PN) and subsequent transplantation. Methods: A total of 35 short gut syndrome (SGS) patients received glucagon-like peptide-2 (GLP-2) and were followed from April 2013 through February 2019 in the Cleveland Clinic-Center for Gut Rehabilitation and Transplantation. Of these, 34 were adults with a mean age of 53.4 ± 12.6 years (range: 14–72) and a female to male ratio of 2.5:1. Thirty-two (91%) of the 35 patients, were PN-dependent and 3 required IV fluid with micronutrient replacement. Leading causes of SGS were vascular occlusion (n=11), inflammatory bowel disease (n=10) and secondary motility disorders (n=5). Autologous gut reconstruction was performed in 32 of the patients (20 at our center and 12 at other institutions) with a mean small bowel length of 88.8 ± 56cm (range 10-220cm). Intestinal lengthening utilizing serial transverse enteroplasty (STEP) was performed in 11 patients. The retained colon was partial in 31 (88.6%) patients and full with intact ileocecal valve in the remaining 4 (11.4%). The duration of GLP-2 therapy ranged from 2 to 63 months with an average dose of 0.32mL/d. Results: With a mean follow up of 34 ± 19 months, 33 patients (94.3%) are currently alive and 2 died of PN-related liver failure and advanced systemic arteriosclerosis. Full nutritional autonomy was achievable in 18 (54.5%) of the 33 current survivors with an overall success rate of 54.5%. Of these 18 patients, 14 (78%) continued to sustain the restored nutritional autonomy for 1 to 48 months after discontinuation of GLP-2 therapy. Meanwhile, a reduction in PN and IV fluid requirements was observed in 19 patients who failed to restore (n=15) or sustain (n=4) nutritional autonomy. None of the patients developed significant complications that warranted permanent discontinuation of GLP-2 therapy. There were no documentation of recurrent or de novo malignancy except in one adult patient who developed prostate cancer. Conclusion: GLP-2 is an effective therapy for patients with SGS-associated intestinal insufficiency. This novel treatment should be more frequently utilized as a primary therapy or as an adjunct to autologous reconstruction and bowel lengthening. In addition, such a biologic agent should considered as an innovative approach to enhance the recovery and function of rejected intestinal allografts.