Chyme recycling in the management of small bowel double enterostomy in pediatric and neonatal populations: A systematic review

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. (C) 2020 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.