LB054 - CHYME REINFUSION THERAPY: COMPARATIVE CASE STUDIES

LB054

CHYME REINFUSION THERAPY: COMPARATIVE CASE STUDIES

G. Hardy¹, M. Cordeiro Arruda^2,*, T. S. Perera³

¹R&D, Ipanema Trust, Auckland , New Zealand, ²Nutrition & Dietetics, Hospital Nossa Senhora do Pilar,, Curitiba, Brazil, ³Clinical Nutrition, National Hospital, Colombo, Sri Lanka

Rationale: Intestinal failure (IF) from colorectal cancer surgery can lead to sepsis, malnutrition, electrolyte and liver function tests (LFT) imbalances. Chyme reinfusion therapy (CRT) has been shown to minimize these complications and improve nutrient absorption, but its implementation can be challenging without specialized teams or equipment. 

Methods: The practicalities of manual (MCRT) versus pump-assisted (PACRT) for nutritional management of high output IF are compared in Cases from Brazil and Sri Lanka. 

Results: A 56y♂ underwent emergency pelvic exenteration for obstructive upper rectal cancer with intestinal infiltration requiring multiple surgeries, resulted in a high output double enterostomy. When parenteral nutrition (PN) failed to correct her severe malabsorption, the multidisciplinary team (MDT) initiated MCRT using an improvised system with an enteral feeding tube in the jejunostomy. Despite initial technical difficulties, after 5 days MCRT improved fluid balance, nutritional parameters and AST:122 to 16, ALT:222 to 46, GGT: 2238 to 1282, ALP: 647 to 297,BIL: 2.05 to 0.89 mg/dL, but the practical challenges of the labour intensive, time-consuming MCRT, caused the procedure to be discontinued after 10d.

In comparison, after 11 weeks PACRT another 56y♂ with a high output ileostomy resulting from intestinal obstruction with an ileal tear, gained weight, improved muscle strength, albumin, hydration, electrolytes with similar improvements in LFT and successfully undergoing reconnective surgery³. Abdominal pain and discomfort, obstruction and/or dislocation of the feeding tube with other technical complications were more frequent with MCRT, whereas PACRT achieved 100% output reinfusion with minimal PN and demonstrated greater procedural efficacy with high nursing and patient satisfaction.

Conclusion: These cases confirm CRT as a viable strategy for management of nutritional and liver status for high output enteric fistulas but also underscores the need for appropriate technology and multidisciplinary teamwork to optimize IF patient rehabilitation.

Disclosure of Interest: G. Hardy Consultant for: 0 , Other: zero, M. Cordeiro Arruda: None declared, T. Perera: None declared