Intestinal Lengthening in Adult Patients with Short Bowel Syndrome

Yannam, Govardhana Rao; Sudan, Debra; Grant, Wendy J.; Botha, Jean F.; Langnas, Alan Norman; Thompson, Jon S.

doi:10.1007/s11605-010-1291-y

Cited by 56 publications

(33 citation statements)

References 20 publications

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“…Yannam et al 171 reported the results of intestinal lengthening procedures in adult patients, including 6 Bianchi and 15 STEP procedures: PN independence was achieved in 59% and a further 18% demonstrated improved enteral caloric intake.…”

Section: Autologous Gastrointestinal Reconstructionmentioning

confidence: 99%

Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

140

108

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SummaryBackgroundHome parenteral nutrition (HPN) is currently the management of choice for patients with chronic intestinal failure.AimTo summarise the major issues in delivering long‐term parenteral nutrition (>3 months) and assess outcome as per complications, mortality and quality of life. To assess the evidence for the therapeutic use of trophic factors such as teduglutide and to review evolving therapeutic options in the treatment of chronic intestinal failure.MethodsA literature search using PubMed and MEDLINE databases was performed.ResultsSafe delivery of HPN relies upon individualised formulations of parenteral nutrition administered via carefully maintained central venous catheters by trained patients or carers, supported by a skilled multidisciplinary team. Early diagnosis and treatment of complications including catheter‐associated blood stream infection (reported incidence 0.14–0.83 episodes/patient‐year on HPN) and central venous thrombosis (reported incidence 0.03 episodes/patient‐year) is important to minimise mortality and morbidity. There is a significant variation in the reported incidence of both hepatobiliary complications (19–75%) and advanced liver disease (0–50%). Five‐year survival rates in large centres are reported between 60% and 78% with survival primarily related to underlying diagnosis. Long‐term survival remains higher on HPN than with intestinal transplantation. The role of intestinal lengthening procedures is yet to be validated in adults.ConclusionsHome parenteral nutrition delivered by skilled nutrition teams has low incidences of catheter‐related complications. Most deaths relate to the underlying disease. Therapies such as teduglutide and small bowel transplantation appear promising, but home parenteral nutrition appears likely to remain the bedrock of management in the near term.

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Section: Autologous Gastrointestinal Reconstructionmentioning

confidence: 99%

Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

140

108

View full text Add to dashboard Cite

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“…Evaluaciones recientes comunican resultados satisfactorios, tanto que algunos autores consideran que es una técnica subutilizada. En una serie de 14 adultos con una mediana de ID remanente de 45 cm, se logró un porcentaje medio de incremento de la longitud intestinal de 52% 23,24 . Según estas observaciones sería prudente considerarla como indicada en pacientes que tengan menos de 100 cms de ID remanente y ausencia o segmento muy cortos de colon.…”

Section: Discussionunclassified

Insuficiencia intestinal secundaria a síndrome de intestino corto: resultados de un programa multidisciplinario de rehabilitación intestinal

et al. 2016

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“…Nevertheless, there is need to improve the long-term results, probably through improved patient selection, evolution of the graft type toward multivisceral transplantation, and new modalities of immuno-suppressive therapy. For patients who do not meet the selection criteria for intestinal transplantation, other surgical alternatives exist (intestinal lengthening and segmental reversal of the small bowel) with interesting results with regard to the ability to wean from PN and for patient survival [16,34].…”

Section: Discussionmentioning

confidence: 99%

Intestinal transplantation: Indications and prospects

Beyer-Berjot

Joly

Dokmak

et al. 2012

Journal of Visceral Surgery

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Intestinal transplantation (IT) can involve small bowel transplantation alone, or be associated with liver or multivisceral transplantation. Although IT is the radical treatment for intestinal failure, home parenteral nutrition (PN) remains the treatment of choice for this disease. Indications for IT are still debated. A recent study showed that early referral for IT is recommended for patients with life-threatening combined liver and intestinal failure or for patients with invasive intra-abdominal desmoid tumors. In the same study, no survival benefit was shown for patients undergoing IT for ultra-short bowel or major complications related to the PN catheter; indications still need to be fully assessed. While short-term outcomes for IT have improved dramatically (one-year survival for small bowel-alone IT is now 80% versus 0-28% in the 1980s), long-term outcomes have not improved much since the introduction of Tacrolimus in the 1990s: five-year survival still does not exceed 60%. Some prospective developments could improve these results: the use of multivisceral grafts, the use of Sirolimus and Thymoglobulins in the immunosuppressive treatment, or the use of new biochemical markers for early diagnosis of graft rejection.

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Intestinal Lengthening in Adult Patients with Short Bowel Syndrome

Abstract: Bowel lengthening is technically feasible and effectively leads to weaning from PN in more than half of the adult patients. Lengthening procedures may be an underutilized treatment for adults with short bowel syndrome.

Cited by 56 publications

References 20 publications

Review article: the management of long‐term parenteral nutrition

Review article: the management of long‐term parenteral nutrition

Insuficiencia intestinal secundaria a síndrome de intestino corto: resultados de un programa multidisciplinario de rehabilitación intestinal

Intestinal transplantation: Indications and prospects

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