P-40: Management of Intestinal Failure from an Intestinal Rehabilitation Unit in the Middle East

Abstract

Introduction: To date, in the Middle East no center has yet to establish an intestinal rehabilitation unit specializing in care for patients with intestinal failure.In this study we report our experiences with an intestinal rehabilitation unit (IRU) in a country without home parenteral nutrition (HPN). Methods: Our IRU was first set up in February 2018. All patients diagnosed with intestinal failure (IF) up to February 2020 have been included in this report. Results: In total, 349 individuals referred to our IRU for treatment. One hundred individuals were diagnosed with IF, among which 68% of patients were males. The mean (SD) age of patients was 46.3 ± 16.1 years. In our series the most prevalent causes for IF included ECF (32%), SBS (24%, which included mesenteric ischemia and repeated surgery as the most common causes of SBS), SBS+fistula (22%), post-operative prolonged ileus (7%), advanced cancer (6%) and chronic intestinal pseudo obstruction (5%), respectively. The median (IQR) amount of days patients received parenteral nutrition (PN) was 32 (18, 60) days. Regarding autologous gastrointestinal reconstruction, resection and anastomosis was performed in 75.4% of patients, serial transverse enteroplasty procedure (STEP) was done in 10.5% and closure of ostoma was done in 7% of patients. In total, six patients had isolated ITxs and three had multivisceral transplantations. Median (IQR) hospitalization time and length of ICU stay were 33 (17.5, 61) and 3 (0, 5.6) days, respectively. Based on the Clavien-Dindo classification, 29%, 26%, 18%, 9% and 2% developed complications grades 1, 2, 3A, 4 and 5, respectively. Overall, 45% of patients developed sepsis, 43% developed catheter infections, 20% catheter thrombosis and 18% developed sludge or gall stones. During the study period, 61% became off PN, 23% of them became candidates for ITx and 16% died, respectively. Conclusion: Establishing an IRU and applying reconstruction techniques, especially in countries without facilities for HPN, will aid in the management of patients with IF and will decrease the number of deaths and number of candidates for ITx.