Clinical nutrition ESPEN · 2026
Chyme reinfusion for management of double enterostomies and entero-atmospheric fistulae in adult patients: An updated systematic review.
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Keane Celia, Wells Cameron, Bhat Sameer, Liu Chen
Аннотация
BACKGROUND & AIMS: Management of intestinal failure is costly, complex and associated with significant morbidity. Emerging evidence suggests that chyme reinfusion therapy is a safe, effective and promising technique in patients with intestinal failure. This review aims to assess the safety and benefits of chyme reinfusion therapy among patients with double enterostomy or enteroatmospheric fistulae.
METHODS: A systematic review of the literature was conducted on 23rd March 2025. MEDLINE, EMBASE, CINAHL, Cochrane Library, and Scopus databases were searched for literature published between January 2019 and March 2025. Conference proceedings from 21 intestinal failure, gastroenterology, and gastrointestinal surgical conferences were searched on 7th April 2025. Articles eligible for inclusion reported on clinical or economic outcomes for CRT (using any method) performed in adult patients with an enterostomy or intestinal fistula, irrespective of the study design. Exclusion criteria were studies of neonatal or paediatric patients, animal studies, letters, editorials, and books. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklists. A narrative synthesis was performed.
RESULTS: Twenty-six reports from 23 studies provided outcomes for 620 patients undergoing CRT. Eighty per cent of patients (8 studies) ceased parenteral nutrition following CRT, with significant reductions in a further 5 studies. There were improvements in weight or BMI in 11 studies, reduction in intestinal output in 7 studies, correction or improvement in liver function test derangement in 8 studies, and improved markers of enterocyte function in 4 studies. Despite some technical issues and common early gastrointestinal side effects, CRT was well tolerated with few major adverse events.
CONCLUSIONS: This updated systematic review supports current evidence that CRT is safe and beneficial for patients with IF secondary to DES or EAF, particularly due to reduction of parenteral nutrition and stomal losses, correction of biochemical LFT derangement, and improved enterocyte function. Built-for-purpose devices appear to improve usability, but appropriate patient selection remains essential to ensure benefit and mitigation of harm with these devices. We hope this review will provide a contemporary overview of the evidence and the knowledge gaps regarding chyme reinfusion therapy.
REGISTRATION: PROSPERO (ID: CRD42023389095).
METHODS: A systematic review of the literature was conducted on 23rd March 2025. MEDLINE, EMBASE, CINAHL, Cochrane Library, and Scopus databases were searched for literature published between January 2019 and March 2025. Conference proceedings from 21 intestinal failure, gastroenterology, and gastrointestinal surgical conferences were searched on 7th April 2025. Articles eligible for inclusion reported on clinical or economic outcomes for CRT (using any method) performed in adult patients with an enterostomy or intestinal fistula, irrespective of the study design. Exclusion criteria were studies of neonatal or paediatric patients, animal studies, letters, editorials, and books. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklists. A narrative synthesis was performed.
RESULTS: Twenty-six reports from 23 studies provided outcomes for 620 patients undergoing CRT. Eighty per cent of patients (8 studies) ceased parenteral nutrition following CRT, with significant reductions in a further 5 studies. There were improvements in weight or BMI in 11 studies, reduction in intestinal output in 7 studies, correction or improvement in liver function test derangement in 8 studies, and improved markers of enterocyte function in 4 studies. Despite some technical issues and common early gastrointestinal side effects, CRT was well tolerated with few major adverse events.
CONCLUSIONS: This updated systematic review supports current evidence that CRT is safe and beneficial for patients with IF secondary to DES or EAF, particularly due to reduction of parenteral nutrition and stomal losses, correction of biochemical LFT derangement, and improved enterocyte function. Built-for-purpose devices appear to improve usability, but appropriate patient selection remains essential to ensure benefit and mitigation of harm with these devices. We hope this review will provide a contemporary overview of the evidence and the knowledge gaps regarding chyme reinfusion therapy.
REGISTRATION: PROSPERO (ID: CRD42023389095).