Experiences with intestinal failure from an intestinal rehabilitation unit in a country without home parenteral nutrition

• Published in: JPEN. Journal of parenteral and enteral nutrition Vol. 46; no. 4; p. 946
• Main Authors: Nikoupour, Hamed, Arasteh, Peyman, Shamsaeefar, Alireza, Ghanbari, Fardin, Boorboor, Arash, Almayali, Ali Mosa Jafar, Shafiekhani, Mojtaba, Samidoust, Pirouz, Shahriarirad, Reza, Shojazadeh, Alireza, Ranjbar, Keivan, Darabi, Mohammad Hasan, Tangestanipour, Sina, Hosseini, Seyed Morteza, Zahiri, Leila, Nikeghbalian, Saman
• Format: Journal Article
• Language: English
• Published: United States 01.05.2022
• Subjects: intestinal rehabilitation; intestinal failure; intestine; parenteral nutrition; organ transplantation; total parenteral nutrition; short-bowel syndrome
• ISSN: 1941-2444
• DOI: 10.1002/jpen.2231

For the first time, we reported experiences with an intestinal rehabilitation unit (IRU) from a country without home parenteral nutrition (HPN). We included patients with a diagnosis of intestinal failure (IF) since the establishment of our IRU from February 2018 to February 2020. We further report on our protocols for management of enterocutaneous fistulas (ECFs), short-bowel syndrome (SBS), chronic intestinal pseudo-obstruction and motility disorders. Among a total of 349 patients who have been admitted, 100 patients had IF and were included . Mean (SD) age of patients was 46.3 ± 16.1 years. Most common cause of IF was ECFs (32%), SBS (24%), and SBS + fistula (22%). Most common causes of SBS were mesenteric ischemia (63.3%) and repeated surgery (22.4%). Median (interquartile range [IQR]) duration of parenteral nutrition (PN) for patients was 32 (18-60) days. The most common reconstructive surgery performed was resection and anastomosis (75.4%), followed by serial transverse enteroplasty procedure (10.5%) and closure of ostoma (7%). Patients were hospitalized for a median (IQR) of 33 (17.5-61) days. Most common complications were sepsis (45%), catheter infections (43%), and catheter thrombosis (20%), respectively. At the final follow-up, 61% stopped receiving PN, 23% became candidates for transplantation, and 16% died. Considering that most countries lack facilities for HPN, by establishing IRUs using specific treatment protocols and autologous gastrointestinal reconstruction techniques will provide a means to manage patients with IF, thus decreasing death rates and number of patients who require intestinal transplantations due to IF.