Avoiding the use of long‐term parenteral support in patients without intestinal failure: A position paper from the European Society of Clinical Nutrition & Metabolism, the European Society of Neurogastroenterology and Motility and the Rome Foundation for Disorders of Gut–Brain Interaction

Author:

Lal S.1ORCID,Paine P.2,Tack J.34,Aziz Q.5,Barazzoni R.6,Cuerda C.7,Jeppesen P.8,Joly F.9,Lamprecht G.10,Mundi M.11,Schneider S.12,Szczepanek K.13,Van Gossum A.14,Wanten G.15,Vanuytsel T.3,Pironi L.1617

Affiliation:

1. National Intestinal Failure Reference Centre Northern Care Alliance and University of Manchester Salford, Manchester UK

2. Department of Gastroenterology Northern Care Alliance and University of Manchester Salford, Manchester UK

3. Translational Research Center for Gastrointestinal Disorders KU Leuven Leuven Belgium

4. Rome Foundation Raleigh North Carolina USA

5. Blizard Institute, Wingate Institute for Neurogastroenterology, Centre for Neuroscience, Surgery and Trauma Queen Mary University of London London UK

6. Department of Medical, Surgical and Health Sciences University of Trieste Trieste Italy

7. Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit Hospital General Universitario Gregorio Marañón Madrid Spain

8. Department of Gastroenterology Rigshospitalet Copenhagen Denmark

9. Department of Gastroenterology and Nutritional Support, Center for Intestinal Failure, Reference Centre of Rare Disease MarDI, AP‐HP Beaujon Hospital University of Paris Inserm UMR Paris France

10. Division of Gastroenterology and Endocrinology, Department of Medicine II Rostock University Medical Center Rostock Germany

11. Division of Gastroenterology and Hepatology Mayo Clinic College of Medicine Rochester Minnesota USA

12. Gastroenterology and Nutrition Centre Hospitalier Universitaire de Nice, Université Côte d'Azur Nice France

13. General and Oncology Surgery Unit Stanley Dudrick's Memorial Hospital Skawina Poland

14. Medico‐Surgical Department of Gastroenterology Hôpital Erasme, Free University of Brussels Brussels Belgium

15. Intestinal Failure Unit, Department of Gastroenterology and Hepatology Radboud University Nijmegen Medical Centre Nijmegen The Netherlands

16. Department of Medical and Surgical Sciences University of Bologna Bologna Italy

17. Centre for Chronic Intestinal Failure, IRCCS AOUBO Bologna Italy

Abstract

AbstractThe role of long‐term parenteral support in patients with underlying benign conditions who do not have intestinal failure (IF) is contentious, not least since there are clear benefits in utilising the oral or enteral route for nutritional support. Furthermore, the risks of long‐term home parenteral nutrition (HPN) are significant, with significant impacts on morbidity and mortality. There has, however, been a recent upsurge of the use of HPN in patients with conditions such as gastro‐intestinal neuromuscular disorders, opioid bowel dysfunction, disorders of gut–brain interaction and possibly eating disorders, who do not have IF. As a result, the European Society of Clinical Nutrition and Metabolism (ESPEN), the European Society of Neuro‐gastroenterology and Motility (ESNM) and the Rome Foundation for Disorders of Gut Brain Interaction felt that a position statement is required to clarify – and hopefully reduce the potential for harm associated with – the use of long‐term parenteral support in patients without IF. Consensus opinion is that HPN should not be prescribed for patients without IF, where the oral and/or enteral route can be utilised. On the rare occasions that PN commencement is required to treat life‐threatening malnutrition in conditions such as those listed above, it should only be prescribed for a time‐limited period to achieve nutritional safety, while the wider multi‐disciplinary team focus on more appropriate biopsychosocial holistic and rehabilitative approaches to manage the patient's primary underlying condition.

Publisher

Wiley

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