Chyme Reinfusion Research Articles

Nutrition management of intestinal failure: From neonates to the elderly

Double enterostomies (DES) and necrotising enterocolitis (NEC) are prevalent in neonatal intensive care units (NICU), commonly resulting from surgical removal of diseased intestine. Sarcopenia prevalence is >40% in community dwelling elderly >65 yrs and is associated with poor nutritional status before/after abdominal surgery, with intestinal failure (IF) and high output stoma losses. Parenteral Nutrition (PN) is the standard of care for Type 2 IF patients with DES or enteroatmospheric fistulas (EAF), but risks catheter-related complications, infection, gut and hepatobiliary dysfunction. Chyme reinfusion therapy (CRT) is a recommended distal feeding technique that may minimise these risks.

Is chyme reinfusion therapy efficacious for the elderly?

Is chyme reinfusion therapy efficacious for the elderly?

Chyme reinfusion therapy: Efficacy and outcomes from a national intestinal failure unit

Chyme reinfusion therapy: Efficacy and outcomes from a national intestinal failure unit

Chyme reinfusion in a clinical setting

Chyme reinfusion in a clinical setting

Evaluating the efficacy and safety of neonatal chyme reinfusion therapy: A feasibility study using a novel medical device

Neonatal and pediatric intestinal failure related to enterostomy is an infrequent but burdensome condition associated with substantial morbidity and mortality. This study presents the development and clinical validation of a novel device to resolve these problems, by formalizing a safe and efficient enterostomy chyme reinfusion technique. A novel neonatal chyme reinfusion device was designed and manufactured ('The Insides Neo', The Insides Company, New Zealand), prior to validation in a feasibility study in tertiary neonatal intensive care centres. Neonates with double enterostomy were recruited and commenced on chyme reinfusion therapy using the novel device to test safety, efficacy, tolerability, and usability within nursing workflows. Device and clinical outcomes were recorded along with nursing feedback. Registered under the ANZCTR, identifier no. ACTRN12621000835842p. Ten neonates were recruited across two centres, with a median usage duration of 37.5 (range 12-84) days. Following initiation of therapy, rate of weight gain increased from mean 68.8±37.4 to 197±25.0g/week (p=0.024). Of the 7/10 neonates on PN at commencement of therapy, 4/7 were able to wean and achieve enteral autonomy. All neonates tolerated the device with uniformly positive nursing feedback and minimal time to learn and incorporate the novel device into nursing workflows. There were no device-related adverse events. A novel device was developed and validated to be safe and effective at performing chyme reinfusion therapy in neonates. This device is anticipated to improve the clinical care and outcomes of neonatal patients with double enterostomies.

Three patient case series on first use of a novel neonatal chyme reinfusion therapy system

Three patient case series on first use of a novel neonatal chyme reinfusion therapy system

Chyme reinfusion in a double-barreled stoma using the insides system: A cohort study

Chyme reinfusion in a double-barreled stoma using the insides system: A cohort study

Chyme reinfusion with the insides system®: Case series report

Chyme reinfusion with the insides system®: Case series report

A clinical registry for chyme reinfusion therapy patients: A preliminary analysis

A clinical registry for chyme reinfusion therapy patients: A preliminary analysis

Chyme reinfusion therapy using new technology

High output double enterostomies (DES) and disease-related malnutrition (DRM) are features of intestinal failure (IF) that require parenteral nutrition (PN) until surgical re-establishment of intestinal continuity. PN risks include gut and hepatobiliary dysfunction and Intestinal failure associated liver disease (IFALD), defined as hepatobiliary dysfunction with elevated liver function tests (LFT). Chyme reinfusion therapy (CRT) is a distal feeding technique recommended for restoration of digestive function.

Chyme reinfusion with The Insides System: case series report

Chyme reinfusion with The Insides System: case series report

Pharmaceutical and nutritional aspects of chyme reinfusion therapy for IF patients

Pharmaceutical and nutritional aspects of chyme reinfusion therapy for IF patients

Chyme reinfusion for double enterostomy: a preliminary real-life experience with a novel reinfusion device

Chyme reinfusion for double enterostomy: a preliminary real-life experience with a novel reinfusion device

First use of a novel pump device for chyme reinfusion

First use of a novel pump device for chyme reinfusion

424 Early Outcomes of the Insides Chyme Reinfuser (ICR) in the Management of High-Output Stoma

Abstract Aim High-output stomas present a significant surgical, nursing, nutritional and patient challenge. Patients are at risk of complications ranging from disrupted GI and renal physiology to severe complications from vascular access. The ICR device allows chyme to be reinfused and may be a promising way to establish early enteral feeding, shorten hospital stays, and reduce complications such as significant GI losses and prolonged parenteral feeding. We aimed to investigate the early outcome of ICR in our initial cohort of patients. Method Prospective analysis of all patients using ICR from 2020-2022. Outcomes included: primary pathology, hospital stay, duration of Parenteral nutrition, albumin level, commencement and tolerance of Chyme reinfusion, and mortality. Results Eight patients used ICR. Five became independent in using the device. Four were successfully reversed with one waiting reversal. In all patients, a significant reduction in using parenteral nutrition was noted as five patients were nutritionally autonomous whilst using ICR. Although an imperfect marker, albumin levels responded to ICR use (an average improvement from 31g/L to 38g/L). One patient died due to complications from the primary pathology. Conclusions The ICR device is safe and effective. It can be used by nursing patients and most patients. Our data suggest a possible reduction in TPN use which will have financial and clinical benefits. The ICR device should be considered in selected patients. There remains considerable mortality in patients with significant co-morbidity who are left with a high-output stoma.

A stomal therapists experience of a novel chyme reinfusion device for high output enterostomies: A case series instituting a novel chyme reinfusion device in three patients

Background: Reinfusing chyme down the distal limb of an enterostomy is a well-researched technique for helping prevent dehydration and electrolyte loss from a high-output enterostomy. However, it has not gained traction because it is a labour-intensive task that requires nursing management and further in-hospital care. A novel chyme reinfusion device that a patient can manage is now available (The InsidesTM System, The Insides Company, New Zealand). Cases: This paper explores a stomal therapist's experience instituting The InsidesTM System for three patients with high output enterostomies. The reinfusion device is a simple set-up that has been shown to reduce fluid and electrolyte imbalances, reduce and remove the need for parenteral nutrition and is patient managed. Patient experience and learning points gained from the three participants were collected across the themes of patient consent, education of patients and carers, custom tube installation into the distal limb, usability testing and feedback to the device developers. Conclusions: The novel chyme reinfusion device is a simple patient-managed solution that is easy to install and initiate. Clinical benefits include preventing dehydration and electrolyte loss from high-output double enterostomies. By instituting a thorough supportive follow-up management plan for each patient, there were minimal complications with high patient compliance and satisfaction.

Nutritional outcomes of chyme reinfusion therapy for ostomy and fistula patients

Nutritional outcomes of chyme reinfusion therapy for ostomy and fistula patients

Effect of preoperative predigested formula vs. polymeric formula on bowel function recovery after definitive surgery for small intestinal entero-atmospheric fistula in patients with chyme reinfusion.

The purpose of this study is to compare the effect of preoperative predigested formula vs. polymeric formula on bowel function recovery following definitive surgery (DS) for small intestinal enteroatmospheric fistula (EAF). In this retrospective study, from January 2005 to December 2019, the patients with small intestinal EAF and receiving a DS were enrolled. During the preoperative treatment, each patient received enteral nutrition via nasojejunal feeding and chyme reinfusion. The enrolled subjects were classified into two groups, based on their formula type: polymeric formula and predigested formula. Then, propensity scores matching (PSM) was used to further divide these patients into PSM polymeric formula group or PSM predigested formula group. The clinical characteristics of the groups were analyzed. A total of 137 patients were finally enrolled, with 72 patients in the polymeric formula group and 65 patients in predigested formula group. The postoperative ileus was manifested in a total of 61 (44.5%) cases, with 27 (37.5%) in the polymeric formula group and 34 (52.3%) in the predigested formula group (P = 0.04). It was predicted that the polymeric formula could result in a reduction in postoperative ileus (OR = 0.47; 95% CI: 0.21-0.95; P = 0.04). After 1:1 PSM, there were 110 patients included. The postoperative ileus was observed in 47 patients, with 18 (32.7%) in the polymeric formula group and 29 (52.7%) in the predigested formula group (P = 0.03). After PSM, the polymeric formula demonstrated a reduction in the incidence of postoperative ileus (OR = 0.42; 95% CI: 0.19-0.92; P = 0.03). Compared with predigested formula, the preoperative polymeric formula appears to be associated with earlier recovery of bowel function after DS for EAF.

Fistuloclysis and Chyme Reinfusion: Novel Feeding in a Rare Case with Multiple Fistulae following Surgery

Fistuloclysis and chyme reinfusion is a complex method of feeding that has not been widely used at our tertiary hospital. This case study of this 62-year-old male admitted with post-operative complications to our facility for consideration of surgical repair.

Chyme Reinfusion Reducing the Postoperative Complications After Definitive Surgery for Small Intestinal Enteroatmospheric Fistula: A Cohort Study.

PurposeThis study is aimed to reveal the role of preoperative chyme reinfusion (CR) in reducing the complications occurring after definitive surgery (DS) for small intestinal enteroatmospheric fistula (EAF).MethodsIn this study, from January 2012 to December 2019, the patients with small intestinal EAF and receiving a definitive surgery were recruited. Depending on whether the CR has been performed, these patients were divided into either the CR group or the non-CR group. Then, propensity scores matching (PSM) was used to further divide these patients into the PSM CR group or the PSM none-CR group. The clinical characteristics exhibited by the groups were analyzed, and the effect of preoperative CR was investigated.ResultA total of 159 patients were finally recruited with 72 patients in the CR group and 87 patients in the non-CR group. The postoperative complications were manifested in a total of 126 cases (79.3%). There were 49 cases in the CR group, and 77 cases in the non-CR group. CR was associated with the occurrence of postoperative complications (multivariate odds ratio [OR] = 0.289; 95% CI: 0.123–0.733; p = 0.006). After 1:1 PSM, there were 92 patients included. The postoperative complications were observed in 67 out of these 92 patients. There were 26 patients in the PSM CR group, and 41 patients in the PSM non-CR group. CR was associated with postoperative complications (multivariate OR = 0.161; 95% CI: 0.040–0.591; p = 0.002). In addition, CR played a role in reducing the recurrence of fistula both before (multivariate OR = 0.382; 95% CI: 0.174–0.839; p = 0.017) and after (multivariate OR = 0.223; 95% CI: 0.064–0.983; p = 0.034) PSM. In addition, there is a protective factor at play for those patients with postoperative ileus before (multivariate OR = 0.209; 95% CI: 0.095–0.437; p < 0.001) and after (multivariate OR = 0.222; 95% CI: 0.089–0.524; p < 0.001) PSM. However, the relationship between CR and incision-related complications was not observed in this study.ConclusionPreoperative CR is effective in reducing postoperative complications after definitive surgery was performed for EAF.