Andre Lee, Flavio Galvao, Dan Waitzberg, Daniel Waisberg, Rafael Pecora, Andre David, Luiz D'Albuquerque

Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil

Introduction: Since 1991, the ambulatory of Short Bowel Syndrome (SBS) from Clinic Hospital of University of São Paulo Medical School provided gratuity nutritional support for more than 120 patients with SBS.

Objective: To study the evaluation of patients receiving Home Total Parenteral Nutrititon (HTPN) and indication of intestinal and multivisceral transplantation.

Methods: A total of 28 patients with SBS receiving HTPN were evaluated for a period of 6 months. We assessed the etiology of SBS, clinical complications, indication of intestinal transplantation and mortality rate.

Results: After the study period 14 patients (50%) continued exclusively in HTPN and 50% recovered oral nutrition. All HTPN-dependents became potential referrals for intestinal transplantation. Four cases achieved formal indication of intestinal transplantation, three isolated (assess thrombosis in 1 and catheter infection in 2) and 1 for multivisceral (portomesenteric thrombosis). Their mean age was 39.79 ± 14.94 years (60% male and 40% female). The main diseases were: intestinal pseudobstruction (20%), mesenteric thrombosis (16%), trauma (16%), intestinal malrotation (10%), non-Hodgkin lymphoma (10%), colon cancer + mesenteric thrombosis (6%), Appendicitis + peritonitis (10%), Crohn’s Disease (3%), Gardner syndrome (3%), peritoneal dialysis + peritonitis (3%), provoked abortion (3%). Complications of HTPN included: catheter infection (85%), subclavian/julgular vein thrombosis (65,60%), liver steatosis (38%), cholelithiasis (16%), cholestasis (13%), nephrolothiasis (10%) and electrolytes disturbance (22%). Mean number of central line infections was 2.00 ± 1,62. During follow-up, 53% patient died (53% from HTPN complication, 41% from sepsis and central line infections, 3% from heart infarction and 3% from electrolyte disturbance).

Conclusion: HTPN may improve the survival in SBS if a qualified multidisciplinary group assists patients; however, the incidence of morbidity-mortality in these patients is high. Intestinal transplantation is the best therapeutic option that can improve survival and the quality of life of these patients.