SP2.10 - Early outcomes with the Insides Chyme Reinfusor (ICR) device in the management of parenteral nutrition dependent high output stomas (PN-HOS)

Abstract Aims PN-HOS represent a complex challenge, requiring input from surgical, gastroenterology and nutritional teams. Length of stay (LOS) is prolonged with difficulties in achieving output control and adequate nutrition with other associated risks. ICR is a modified stoma bag/mechanical pump and catheter device, reinfusing chyme into the distal limb, maintaining gut continuity, preserving enteral nutrient absorption and preventing distal limb atrophy. ICR may accelerate establishment of nutritional autonomy and reduce costs associated with PN/LOS. We report the largest study of ICR outcomes Methods Prospective study of ICR outcomes in patients with PN-HOS. Analysis included LOS, duration of PN, establishment of nutritional autonomy, nutritional markers, adverse ICR effects. Results Sixteen patients were trained to use the ICR (6M:10F). Median age 60yr. 75% achieved independent use (median 5.6 days). Overall usage was 395 days (median 32 days). Nutritional autonomy achieved in nine patients (pre-reversal). ICR increased median albumin 10.5 g/l. Adverse events included changing difficulties, spillage, noise, and discomfort. Two patients discontinued ICR because of pain/reflux. One patient died from unrelated post-operative complications. One patient with multiple loop stomas was successfully established on dual ICR. Nursing experience with ICR demonstrated ease of use and straightforward patient education. Cost analysis PN £5000/mth v ICR 1800/mth. Anecdotally at the time of reversal, surgical opinion was of much favourable bowel for anastomosis and return to function. Conclusions The ICR device is safe and contributes to restoration of nutritional autonomy. It reduces PN dependence with cost-benefits and acceptable adverse effects. At time of initial surgery distal limb should be fashioned to allow potential use of ICR.