2017 - CIRTA


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2- Nutrition Management and Total Parenteral Nutrition

18.4 - To avoid chronic intestinal failure: The one-year experience of the first French Intestinal Stroke Center

Presenter: Olivier, Corcos, Clichy, France
Authors: Olivier Corcos, Yves Castier, Léon Maggiori, Annie Sibert, Audrey Huguet, Maxime Ronot, Lore Billiauws, Emmanuel Weiss, Dominique Cazals-Hatem, Yves Panis, Yoram Bouhnik, Catherine Paugam, Francisca Joly

To avoid chronic intestinal failure: The one-year experience of the first French Intestinal Stroke Center

Olivier Corcos1,7,8, Yves Castier2,7,8, Léon Maggiori3,7,8, Annie Sibert4,7, Audrey Huguet1,7, Maxime Ronot4,7,8, Lore Billiauws1,7,8, Emmanuel Weiss6,7,8, Dominique Cazals-Hatem7, Yves Panis3,7,8, Yoram Bouhnik1,7,8, Catherine Paugam6,7,8, Francisca Joly1,7,8.

1SURVI/Intestinal Failure Unit/Nutritional Assistance/Gatroenterology, Beaujon Hospital, Clichy, France; 2Vascular Surgery, Bichat Hospital, Paris, France; 3Digestive Surgery, Beaujon Hospital, Clichy, France; 4Radiology, Beaujon Hospital, Clichy, France; 5Anesthesiology-Intensive Care Unit, Beaujon Hospital, Clichy, France; 6Pathology, Beaujon Hospital, Clichy, France; 7Intestinal Stroke Center- Structure d'URgences Vasculaires Intestinales (SURVI), Beaujon-Bichat Hospital, Clichy, France; 8Université Paris 7- Denis Diderot, Paris, France

Introduction: One of the major cause of chronic intestinal failure in adults is short bowel syndrome due to acute intestinal ischemic injury (i3). We previously showed that acute i3 could be reversible allowing to avoid intestinal resection (1,2). On January 4th, 2016, the Assistance Publique-Hopitaux de Paris institution created an Intestinal Stroke Center (so called SURVI i.e Structure d’URgences Vasculaires Intestinales). This unique structure offers to patients with intestinal ischemic injuries a dedicated multidisciplinary management focusing on intestinal viability. The aim of this study was to describe the results of this management after one year.

Methods: The Intestinal Stroke Center includes an intensive care unit specialized in acute intestinal failure and i3, under the supervision of gastroenterologists. The multimodal and multidisciplinary strategy aimed at targeting intestinal viability and combines a pathophysiological-based medical protocol, a decisional algorithm for radiological and / or surgical arterial revascularization and/or digestive surgery (1,2).

Results: From 04 January to 31 December 2016, 124 patients (mean age 63 years), were admitted to SURVI and prospectively followed. At the admission i was acute and / or chronic in 91 and 45 cases, respectively. The origin of i3 was arterial, venous or both in 104, 19, and 1 case, respectively. Arterial causes were athero-thrombotic (n = 70), embolic (n = 12), dissection (n = 10) or other mechanism (n =12). Revascularization was performed in 54 cases, surgically (n = 25), radiologically (n = 33) or both (n = 5). Intestinal resection (n=47, 38%) was performed before and / or after admission to SURVI in 26 (21%) and 34 (27%) patients, leading to short bowel syndrome in 31 patients (25%). Intestinal failure requiring parenteral nutrition was observed in 23 patients (18%) and in 14 (15%) acute i3patients. Overall survival and survival of acute i3 patients were 87% and 86% respectively, with a median follow-up of 166 (0-374) days.

Conclusion: The management of intestinal ischemic injuries in a dedicated Intestinal Stroke Center allows to reduce mortality and intestinal resection rates to less than 20% and 30%, respectively. The management of intestinal failure should integrate a prevention strategy to avoid large intestinal resection. SURVI could serve as a model for comparable care centers in other regions or countries to improve the global prognosis of intestinal ischemia. 

MSD Avenir.

[1] Corcos O, Castier Y, Sibert A, Gaujoux S, Ronot M, Joly F, et al. Effects of a multimodal management strategy for acute mesenteric ischemia on survival and intestinal failure. Clin Gastroenterol Hepatol. 2013;11:158–65.e2.
[2] Nuzzo A, Corcos O. Reversible Acute Mesenteric Ischemia. New England Journal of Medicine. 2016 Oct 13;375(15):e31.


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