PMID- 32359729
OWN - NLM
STAT- MEDLINE
DCOM- 20210924
LR  - 20210924
IS  - 2405-4577 (Electronic)
IS  - 2405-4577 (Linking)
VI  - 37
DP  - 2020 Jun
TI  - Chyme recycling in the management of small bowel double enterostomy in pediatric 
      and neonatal populations: A systematic review.
PG  - 1-8
LID - S2405-4577(20)30058-9 [pii]
LID - 10.1016/j.clnesp.2020.03.013 [doi]
AB  - BACKGROUND & AIMS: Intestinal failure (IF) in neonatal and pediatric patients is 
      associated with substantial morbidity. Management of IF includes the formation of 
      a double enterostomy (DES) of the small bowel. Parenteral nutrition (PN) is 
      frequently required, which is expensive. Recycling chyme from the proximal DES 
      limb distally is an alternative therapy, but standardized data on this 
      intervention is lacking. This review systematically evaluated the existing 
      literature on chyme recycling (CR) in neonatal and pediatric populations. 
      METHODS: Medical databases were systematically searched for articles reporting CR 
      in neonatal and pediatric populations. Articles documenting CR indications, 
      methods, clinical outcomes, benefits and adverse events (AEs) were reviewed. A 
      narrative synthesis was performed on the extracted data. RESULTS: This review 
      identified 20 full-text articles, in which 289 patients received CR, most 
      commonly following necrotizing enterocolitis (n = 117 patients). The most common 
      motivators for CR were proximally located DES (n = 7 articles) and to support 
      nutrition and growth (n = 7 articles). Proximal DES output collection was 
      predominantly manual (n = 11 articles), whereas distal CR was mostly automated (n 
      = 12 articles), using customized peristaltic or syringe infusion pumps. Clinical 
      benefits encompassed PN reduction (n = 19 patients) or cessation (n = 122 
      patients), weight gain, normalization of fluid balance, improvement in liver 
      function tests and distal gut maturation. Technical problems commonly included 
      tube dislodgement, leakage and effluent reflux (n = 9 articles). AEs included 
      intestinal perforation (n = 3 patients) and haemorrhage (n = 1 patient). 
      CONCLUSIONS: From the limited available data, CR is demonstrated as an effective 
      therapeutic intervention for small bowel DES in pediatric and neonatal patients. 
      However, standardized methods that improve the delivery of and minimise AEs 
      associated with the intervention are needed.
CI  - Copyright (c) 2020 European Society for Clinical Nutrition and Metabolism. 
      Published by Elsevier Ltd. All rights reserved.
FAU - Bhat, Sameer
AU  - Bhat S
AD  - Department of Surgery, Faculty of Medical and Health Sciences, The University of 
      Auckland, Auckland 1023, New Zealand.
FAU - Cameron, Nelle-Rose
AU  - Cameron NR
AD  - Department of Surgery, Faculty of Medical and Health Sciences, The University of 
      Auckland, Auckland 1023, New Zealand.
FAU - Sharma, Puja
AU  - Sharma P
AD  - Department of Surgery, Faculty of Medical and Health Sciences, The University of 
      Auckland, Auckland 1023, New Zealand.
FAU - Bissett, Ian P
AU  - Bissett IP
AD  - Department of Surgery, Faculty of Medical and Health Sciences, The University of 
      Auckland, Auckland 1023, New Zealand.
FAU - O'Grady, Greg
AU  - O'Grady G
AD  - Department of Surgery, Faculty of Medical and Health Sciences, The University of 
      Auckland, Auckland 1023, New Zealand; Auckland Bioengineering Institute, The 
      University of Auckland, Auckland 1010, New Zealand. Electronic address: 
      greg.ogrady@auckland.ac.nz.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20200407
PL  - England
TA  - Clin Nutr ESPEN
JT  - Clinical nutrition ESPEN
JID - 101654592
SB  - IM
MH  - Child
MH  - *Enterostomy
MH  - Gastrointestinal Contents
MH  - Humans
MH  - Infant, Newborn
MH  - *Intestine, Small/surgery
MH  - Intestines
MH  - Parenteral Nutrition
OTO - NOTNLM
OT  - Fistuloclysis
OT  - Refeed
OT  - Reinfuse
OT  - Succus entericus
COIS- Declaration of Competing Interest A/Prof. Greg O'Grady and Prof. Ian P. Bissett 
      hold intellectual property in gastrointestinal nutrient recycling devices and are 
      respective shareholders in The Insides Company (Auckland, NZ). The lead author 
      (Sameer Bhat) and co-authors (Nelle-Rose Cameron and Puja Sharma) declare that 
      they have no conflict of interest related to this work.
EDAT- 2020/05/04 06:00
MHDA- 2021/09/25 06:00
CRDT- 2020/05/04 06:00
PHST- 2019/09/18 00:00 [received]
PHST- 2020/03/11 00:00 [revised]
PHST- 2020/03/16 00:00 [accepted]
PHST- 2020/05/04 06:00 [entrez]
PHST- 2020/05/04 06:00 [pubmed]
PHST- 2021/09/25 06:00 [medline]
AID - S2405-4577(20)30058-9 [pii]
AID - 10.1016/j.clnesp.2020.03.013 [doi]
PST - ppublish
SO  - Clin Nutr ESPEN. 2020 Jun;37:1-8. doi: 10.1016/j.clnesp.2020.03.013. Epub 2020 
      Apr 7.