Starting up Korea's First Intestinal Rehabilitation Program

Abstract

Intestinal failure (IF) is a state in which the insufficiency of bowel mass or function mandates alternative routes of nutrition support other than the oral route. These patients harbor a multitude of presentations and potential complications that require the attention of medical and non-medical experts and the multidisciplinary team approach has proven to be beneficial in the course of their treatment. The concept of IF was not well known in South Korea and these patients have been managed sporadically by medical personnel who were not familiar to the concept of intestinal rehabilitation. We have set up a multidisciplinary intestinal rehabilitation program (IRP) at Samsung Medical Center (Seoul), which is the first of its kind in Korea. The team consisted of surgeons, pharmacists, nutritionists, ward nurses and home-care nurses. Weekly meetings were held among team members to discuss inpatient care and develop standardized protocols for complication monitoring (intestinal failure associated liver disease) and management of enteral and parenteral nutrition supplement, central line associated blood stream infection and at-home care. A multidisciplinary intestinal rehabilitation clinic was also set up for care of patients after discharge and a computerized flowsheet was developed for easier monitoring of patient flow. As of June 2016, 17 patients (11 children and 6 adults) were managed in the IRP. The causes of IF in pediatric patients were short bowel (64%), disorders of motility (27%) and radiation enteritis (9%). In adults malignant obstruction (67%) and short bowel (33%) were the main causes. Full enteral autonomy was achieved in 3 adults and 2 children. Length of initial hospital stay was shortened by more than 12 months before and after the initiation of IRP. In conclusion, we have successfully began Korea's first multidisciplinary IRP. We hope to continue our efforts in adopting more advanced treatment strategies to better care for Korea's IF patients.