PWE-007 Type 2 Intestinal Failure– A large tertiary hospital experience. (June 2019)

• Record Type: Journal Article
• Authors: Hollingworth, Thomas; Bakewell, Lucy; Buse, Elizabeth; Clarke, Emily; Leach, Zillah; Mistry, Priya; Richardson, Carl; Rutter, Charlotte; King, Andrew; Smith, Trevor
• Is Part Of: Gut. Volume 68(2019)Supplement 2
• Page Start: A177
• Page End: A177
• Publication Date: 2019-06
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2019-BSGAbstracts.338
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: Type 2 intestinal failure (IF) is a prolonged (>28 days), acute condition requiring complex multi-disciplinary (MDT) care and intravenous (IV) supplementation, either in hospital or through the provision of home parenteral nutrition (HPN). Without careful MDT management, these patients can progress to type 3 IF, requiring lifelong IV support with associated morbidity. NHS England estimates that there will be an increase in the provision of HPN at a rate of approximately 20% per annum, largely as a consequence of the increase in type 2 IF. The aim of this study was to assess the efficacy of IF surgery that we provide in our tertiary referral centre in reducing the need for ongoing IV support. Secondary end points included the reason that IV support was required, the length of time from commencing IV support to surgery and the underlying pathology that led to the IF. Methods: A prospectively kept database of all patients receiving HPN who underwent IF surgery between September 2009 and July 2018. The notes of these patients were assessed with the dates or referral, length of IV support, reason for IV support, underlying pathology and IV support required following surgery recorded. Results: 77 operations were performed on 76 patients with a median age at the time of operation of 57 (range 1–1). 64 patients received HPN whilst 12 received IV fluids. These patients required IV support prior to an IF laparotomy due to fistulae (31), high output stoma (26), abdominal sepsis (15), and bowel obstruction (5). The underlying pathology that led to their presentation includes inflammatory bowel disease (26), vascular (13), surgical complications (10), malignancy (7), diverticular disease (7), Volvulus (4), Radiotherapy (3), adhesions (2), perforation (2), pancreatitis, TB and in one case unknown. The median time from starting IV support to the date of surgery was 218 days (range 10–67) Of these 92% were able to stop their HPN and 75% had their home IV fluids stopped. 5 patients had their TPN reduced to intravenous fluids and 8 continued with their previous home intravenous support Conclusions: Surgery for type 2 IF, in selected patients who have close MDT management can lead to a significant reduction in the requirement for home IV support, reducing the associated morbidity and mortality. The MDT needs to closely support patients nutritionally, psychologically and physically, allowing time for recovery from the initial insult before embarking on further surgery.