Elsevier

Clinical Nutrition

Volume 31, Issue 6, December 2012, Pages 831-845
Clinical Nutrition

Review
Outcome on home parenteral nutrition for benign intestinal failure: A review of the literature and benchmarking with the European prospective survey of ESPEN

https://doi.org/10.1016/j.clnu.2012.05.004Get rights and content

Summary

Background & aims

Indications and timing for referral for intestinal transplantation (ITx) were investigated through a review of the literature on home parenteral nutrition (HPN) for benign intestinal failure and a benchmarking to the results of a prospective European survey which evaluated the appropriateness of the current indications for ITx.

Methods

Manuscripts reporting outcomes of adults and children on HPN were retrieved through a PubMed search. Data from the European survey were compared with those on HPN reported in the literature, and with those on ITx reported by the USA registry and by the Pittsburgh center.

Results

HPN is a safe treatment with a high probability of survival. The risk of death during HPN is increased by the absence of a specialist team, and appears greater during the early period of treatment. Survival probability is decreased in patients with: age >40 or <2 years, very short bowel remnant, presence of a stoma, chronic intestinal pseudo-obstruction of myopathic origin, systemic sclerosis, radiation enteritis, intra-abdominal desmoids, necrotizing enterocolitis, congenital mucosal diseases. Liver failure is the HPN-related complication with the greatest risk of death. Death related to venous catheter complications is rare. The benchmarking supported the results of the European survey.

Section snippets

Background

Intestinal failure (IF) results from reduction in the functioning gut mass characterized by the inability to maintain protein-energy, fluid, electrolyte and/or micronutrient balance.1 It can be classified into four major pathophysiological conditions: short bowel syndrome (SBS), chronic intestinal pseudo-obstruction (CIPO), small bowel parenchymal disease, and intestinal fistula,2 which may originate from various gastrointestinal or systemic diseases.

SBS is the most frequent cause of IF, and

Literature search

For the purpose of the workshop, a review of the literature was performed by a PubMed search, associating the term HPN with the following additional terms: intestinal failure, SBS, CIPO, Crohn's disease, radiation enteritis, intra-abdominal desmoid tumor, congenital mucosal disease, intractable diarrhoea, and adults or children. The PubMed search was updated in September 2011. The completeness of the PubMed search with respect to the purpose of the review, was verified by repeating the search

Weaning from HPN after intestinal rehabilitation

In adult patients, the probability of weaning from HPN has been reported to be similar between SBS and CIPO in one study20 and more likely in patients with SBS (50%) than for those with CIPO (25%) in another report.6

Three studies in children, showed that the ability to successfully wean from HPN was greater in those with SBS (54%, 42% and 73%, respectively for Refs. 7, 21, 22) than for those with CIPO (38%, 25% and 29%).

Complete HPN weaning in patients with SBS is very unlikely to occur after

Conclusions

With care and support from a specialist team, HPN is a safe treatment with a high probability of long-term patient survival. However, patients with chronic IF may have an increased risk of death due to factors related to HPN, or to the underlying disease for which they require HPN.

Intestinal rehabilitation programs can reverse IF. Most of the patients who are weaned from HPN, will achieve this within the first 2 years after the diagnosis, but complete reversibility can also occur later. This

Conflict of interest

LP: consultancy for NPS/Nycomed; honoraria from Baxter and Fresenius Kabi; payment for educational presentation from B. Braun; travel expenses from Baxter. OG: board membership for Danone; consultancy for Biocodex; grants for research from Assistance Publique Hopitaux de Paris. AB: honoraria, payment for educational presentation and travel expenses from Baxter. SG: consultancy from NPS/Nycomed and Baxter; honoraria from Baxter; travel expenses from NPD/Nucomed. MP: board membership from

Statement of authorship

All authors have made substantial contributions and final approval of the conceptions, drafting, and final version. LP chaired the workshop, designed the review and the benchmarking and drafted the manuscript. OG co-chaired the workshop, contributed to and revised the manuscript. AB, BM, MC and ES contributed to the workshop and contributed and revised the manuscript. SG, GG, MP and ADP contributed to the workshop and revised the manuscript. AF and AVG contributed to the benchmarking and

Acknowledgments

The following members of the Special Interest Group on Home Artificial Nutrition and Chronic Intestinal Failure of the European Society of Clinical Nutrition and Metabolism (ESPEN), actively contributed to the prospective survey that was the aim of the benchmarking of the present study: Francisca Joly, Malgorzata Lyszkowska, Janet Baxter, Cristina Cuerda.

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