[Treatment for Intestinal Failure/Short Bowel Syndrome: Alternatives to Small Bowel Transplantation - What is the International Standard?]

Abstract

In the treatment of chronic intestinal failure/short bowel syndrome (CIF/SBS), the question of small bowel transplantation may arise. However, the results of small bowel and multivisceral transplantation are not satisfactory, particularly regarding long-term patient and organ survival. According to the expert consensus, the utilisation and combination of alternative methods (nutritional therapy, autologous intestinal reconstruction, chyme reinfusion, pharmacotherapy including GLP-2 analogues) leads to good and viable outcomes. The aims of all these therapeutic procedures, which are mostly indicated as being complementary to each other, are optimisation of enteral absorption, the best possible anatomical situation for absorption and home parenteral nutrition, and provide good long-term survival with the best possible quality of life. This holistic optimisation is described by the term "intestinal rehabilitation" and should restore the patient's nutritional autonomy, with a reduction or even complete weaning off parenteral nutrition. Patients with imminent failure of parenteral nutrition as a life-sustaining organ replacement therapy should nevertheless be presented at an early stage to a transplant centre with experience in multivisceral and small bowel transplantation, in order to prepare the change of strategy to life-saving transplantation in good time. According to international standards, patients with CIF/SBS should be treated in an interdisciplinary centre including visceral surgery, gastroenterology, psychology and nutritional medicine.