Chyme reinfusion via percutaneous endoscopic colostomy in type 1 short bowel syndrome with a defunctionalized but intact colon: short-term nutritional outcomes and parenteral support weaning.

BACKGROUND: Short bowel syndrome (SBS) type I, characterized by an end stoma without colonic continuity, poses significant challenges in fluid and electrolyte management. The defunctionalized colon remains dormant before stoma reversal, representing an untapped absorptive reserve. Percutaneous endoscopic colostomy (PEC) provides a minimally invasive route for scheduled chyme reinfusion, yet evidence regarding its nutritional benefits remains limited. This study aimed to examine whether PEC-guided colonic chyme reinfusion before stoma reversal is associated with improved nutritional outcomes in type I SBS patients with preserved colon.

METHODS: This retrospective cohort study included 71 type I SBS patients with retained intact colon undergoing stoma reversal between August 2019 and May 2024. Patients were divided into the PEC group (n = 57, treated after 2021) and the non-PEC historical control group (n = 14, treated before 2021). Nutritional outcomes, including serum albumin, prealbumin, C-reactive protein (CRP), body mass index (BMI), electrolyte supplementation requirements, intravenous fluid requirements, and enteral nutrition tolerance, were assessed at admission and at 2 months after admission. Linear mixed-effects models and logistic regression were used for statistical analysis.

RESULTS: Both groups showed significant improvements in most nutritional parameters over time. The PEC group demonstrated significantly greater reductions in intravenous fluid requirements (1761 vs. 3305 mL, P < 0.0001), sodium supplementation (3.91 vs. 7.63 g, P < 0.0001), and potassium supplementation (2.50 vs. 4.73 g, P < 0.0001) at 2 months. Enteral nutrition tolerance improved more substantially in the PEC group (51.2 vs. 40.0 mL/h, P < 0.0001). Prealbumin levels increased significantly more in the PEC group, with a significant time-by-group interaction (P = 0.014). PEC-related complications occurred in 4 patients (7.0%), all Grade I or II. However, no significant between-group differences were observed in CONUT and NRS2002 scores, albumin, or BMI at the 2-month time point.

DISCUSSION: PEC-guided chyme reinfusion in type I SBS patients with a defunctionalized but intact colon was associated with reduced parenteral fluid and electrolyte requirements, improved enteral tolerance, and increased prealbumin levels within a 2-month preoperative window, with an acceptable safety profile. Global nutritional screening scores showed limited changes, suggesting that the early benefits of PEC are primarily manifested in reduced parenteral support dependence rather than broad nutritional indices. Prospective randomized trials with longer follow-up are warranted to confirm these findings.