Fistuloclysis : an option for the nutritional management of adult intestinal failure patients in South Africa

[摘要] ENGLISH SUMMARY : Introduction: The development of intestinal failure is the consequence of diverse aetiologies and pathophysiological causes. Fistuloclysis is an effective means of nutritional support in selected intestinal failure patients. This study aimed to investigate the management of adult intestinal failure patients in hospitals in South Africa, determining how practical and acceptable fistuloclysis is. Methods: The study included three phases. Phase 1 consisted of a retrospective record review of adult patients admitted to Groote Schuur Hospital Intestinal Failure Unit between January 2009 and May 2014. Data collected included demographics, surgical interventions, gastrointestinal anatomy, nutritional management, biochemical markers and intake and output. Phase 2 consisted of a purposefully selected case study report published in a peer-reviewed journal. Phase 3 investigated the current management of type 2 and type 3 intestinal failure patients in South African hospitals, evaluating perceptions and opinions among South African doctors, stoma therapists and dietitians by means of occupation-specific questionnaires.Results: Phase 1: Seventeen intestinal failure patients receiving fistuloclysis were included in the study. During the fistuloclysis period, the median daily output was 1 478ml with a median of 71% of effluent received back via fistuloclysis. Four patients went home for a median period of 32,5 days on fistuloclysis. There was a statistically significant increase in the median albumin level between day 0 and day 28 of fistuloclysis, however body weight did not improve during this period. Postoperative complications occurred in only three patients. Patients were discharged after a median of 12 days post definitive surgery, with three complicating postoperatively and all patients regaining nutritional autonomy. Phase 3: Twenty-seven dietitians participated in the survey, the majority (67%) having been involved with patient management in this field for one – five years. All indicated high fistula outputs would be defined as intestinal failure. Only 47% gave the correct definition, with 28% currently utilising fistuloclysis. All respondents agreed that unsuccessful implementation of fistuloclysis was due to training shortfalls and resistance from clinicians and nursing staff. Ten stoma therapists entered the survey but only two fitted the inclusion criteria. Both worked in the private sector, with >10 years of experiece in the management of intestinal failure patients. Only one of the two proceeded with further questions. Four doctors managing intestinal failure responded. All respondents indicated high fistula outputs as associated with intestinal failure. The aetiology of intestinal failure indicated was postoperative complications by 75% of the respondents. The majority of respondents (75%) indicated that keeping patients nil by mouth was common practice, 50% of respondents indicated routine usage of pharmacological agents to decrease output or transit time. All respondents gave the correct explanation of fistuloclysis with 50% currently using fistuloclysis.Conclusion: Fistuloclysis is not superior, but equivalent to conventional methods of intestinal failure management. From this study and other available literature it is evident that fistuloclysis can replace PN support in selected patients. From the different occupation group surveys it is evident that there is a positive perception and awareness of fistuloclysis; however numerous stumbling blocks hamper the wider use of this novel treatment.

[发布机构] Stellenbosch University