P471 - CROSSING THE NUTRITIONAL SPECTRUM: HOME PARENTERAL NUTRITION (HPN) AS A RESCUE THERAPY AFTER BARIATRIC SURGERY – IT'S NOT ALWAYS THE SURGERY

P471

CROSSING THE NUTRITIONAL SPECTRUM: HOME PARENTERAL NUTRITION (HPN) AS A RESCUE THERAPY AFTER BARIATRIC SURGERY – IT'S NOT ALWAYS THE SURGERY

I. Papier¹, H. Bar Yoseph², I. Chermesh^2,* on behalf of Home parenteral nutrition clinic Rambam

¹nursing, ²gastroenterology, Rambam health care campus, haifa, Israel

 

Rationale: Bariatric surgery is an effective intervention for patients with obesity who have not achieved sufficient weight loss through non-surgical methods. However, a subset of patients develops impaired oral intake and/or malabsorption, resulting in severe malnutrition that necessitates home parenteral nutrition (HPN). This study aimed to describe the duration of HPN and identify potentially reversible causes for its initiation and cessation in post-bariatric patients

Methods: We retrospectively analyzed data from all patients treated with HPN at our tertiary outpatient clinic between 2003 and April 2025. Patients were included if HPN was initiated post bariatric surgery. A treatment course was defined as the period between initiation and cessation of HPN, with a break of ≥14 days considered a new course. Duration analysis included only completed courses with full follow-up before the time of data analysis.

Results: A total of 676 patients received 722 HPN courses. Of these, 49 patients required HPN following bariatric surgery, accounting for 54 treatment courses. Duration data were available for 42 courses. Mean HPN duration was 193 ± 359 days, with a median of 88.5 days.

Reasons for HPN cessation:

Optimization of nutritional therapy: 22 courses (43%)

Surgery: 10 courses (20%)

Drainage of intra-abdominal collections: 9 (18%)

Endoscopic treatment: 6 (12%)

Other (8%): newly diagnosed conditions including celiac disease (1), Crohn’s disease (1), and pancreatic insufficiency (2)

Conclusion: In 57% of cases, cessation of HPN required active intervention, including surgery, drainage, endoscopy, or identification of a new diagnosis. These findings underscore the importance of thorough diagnostic evaluation to uncover treatable causes of malnutrition in post-bariatric patients, rather than attributing all complications to surgical anatomy alone.

Disclosure of Interest: None declared