O054 - CHYME REINFUSION THERAPY (CRT) IMPROVES LIVER AND NUTRITIONAL STATUS IN INTESTINAL FAILURE

O054

CHYME REINFUSION THERAPY (CRT) IMPROVES LIVER AND NUTRITIONAL STATUS IN INTESTINAL FAILURE

G. Hardy^1,*, J. Davidson², G. Sutherland³, S. Lal⁴, I. Bissett⁵, K. Farrer⁴ on behalf of The Reinfuse RCT Investigator Group

¹Research, Ipanema Trust, ²Research, ³Administration, Insides Company, Auckland, New Zealand, ⁴Intestinal Failure Unit, Northern Care Alliance, Salford, United Kingdom, ⁵Surgery, University of Auckland, Auckland, New Zealand

Rationale: Hepatobiliary dysfunction with elevated liver function tests (LFT) is associated with parenteral nutrition(PN) management of intestinal failure (IF). Earlier studies showed that nutritional status and LFT improve with chyme reinfusion therapy (CRT).¹’²  Further evidence is provided from a multicentre RCT of PN-dependent Type2 IF adults³

Methods: Participants were randomised to device-assisted CRT+PN [Active A] or standard care [Control C] with primary endpoint >50% reduction in PN at 30d. Rate of PN cessation at 30d & 60d, malnutrition risk (MR), nutrition risk index (NRI), LFT and adverse events (AE) were secondary outcomes

Results: Of 39 patients (26A, 13C), 8/26A (31%) achieved the primary endpoint at 30d (p=0.032) and 10/23 (43%) CRT patients had completely ceased PN versus no C at 60d (KM log-rank estimate p=0.008), with improved urine output, reduced chyme losses and 96% patient satisfaction in a 10-point questionnaire. NRI in A moved from moderate to no risk, while C moved from none to moderate risk. A patients with no MR increased from 43.5% to 66.7% but C decreased from 53.8% to 40.0%. Mean BIL, AP, AST/SGOT, ALT/SGPT all decreased in A, but increased in C after 30d & 60d. Ferritin, Zinc, Vits A, D, B¹² improved at 60d with CRT. Device-related AE were mostly mild with one unrelated death. 

Conclusion: This first RCT of device-assisted CRT demonstrates safety, efficacy with improvement in LFT and nutritional markers while achieving early PN weaning in many T2IF patients. It reduces intestinal losses, is well tolerated, with high patient satisfaction. With appropriate training CRT has the potential to become standard of care, improving nutritional status by earlier weaning to enteral/oral feeding and avoiding PN-related complications. Early rehabilitation of the distal bowel before restorative surgery could reduce costs and hospital stay

References: ¹Nutrients 2020:12;1376 ²ESPEN 2023 Poster ³BJS 2026 in press

Disclosure of Interest: G. Hardy Consultant for: None, J. Davidson Shareholder of: none, G. Sutherland Shareholder of: none, S. Lal Other: none, I. Bissett Shareholder of: none, Other: none, K. Farrer Other: none