In the last 20 years, the Intestinal Failure Unit at Salford, Greater Manchester UK has developed the process of fistuloclysis / distal enteral tube feeding (DETF) as an adjunct or alternative to parenteral nutrition (PN) when appropriate. The benefit of DETF is that it can bring about improvements in liver function and in many cases allow PN to be reduced or stopped. For those patients due to undergo restorative surgery, evidence has shown that the administration of enteral feed into the de-functioned part of the bowel prevents, or limits, intestinal atrophy and triggers release of enteroendocrine hormones, including GLP-2. This may help to reduce the risk of post-surgical complications, including anastomotic breakdown. In many cases, these patients are also able to recommence oral diet quickly post-surgery.
More recently we have been using chyme reinfusion therapy (CRT) using The Insides® System, which has the same physiological benefits but, in many cases, has been found to have practical advantages for both nursing staff and patients. These have included：
The cohort of patients for whom we use chyme reinfusion therapy have complex type 2 intestinal failure and therefore the distal limb of bowel may not have been used for a significant period, sometimes years. Therefore, we advise our patients to follow a 3-step process for oral diet, starting with liquids only and building up to a standard low fibre diet. Whilst oral intake is limited, we may also prescribe nutritional supplements to be sure that patients are meeting their nutritional requirements. Initially, our dietetics team will review these patients on a daily basis to monitor their tolerance and provide advice on suitable dietary intake. It is vital that we work very closely with the ward nursing team as they are on hand to support patients throughout the day and night. Patients are encouraged to reinfuse all of their chyme throughout the day and night to ensure that they are getting the maximum benefit. Many of our patients are already on parenteral nutrition and therefore we liaise with our pharmacy colleagues regarding necessary reductions in the nutritional and fluid content of their parenteral nutrition. We have also found that patients may be able to reduce the dose of some medications e.g., loperamide and codeine phosphate. Most patient can go home on CRT, in which case we review them monthly in clinic alongside the medical and nursing team.
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