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Walshaw J, Smith HG, Lee MJ. Small bowel obstruction. Br J Surg 2024; 111:znae167. [PMID: 39041721 DOI: 10.1093/bjs/znae167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 06/16/2024] [Indexed: 07/24/2024]
Affiliation(s)
- Josephine Walshaw
- Leeds Institute of Medical Research, St James's University Hospital, University of Leeds, Leeds, UK
| | - Henry G Smith
- Abdominalcenter K, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Matthew J Lee
- Institute for Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Trauma and Emergency General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Patel PS, Fragkos K, Keane N, Wilkinson D, Johnson A, Chan D, Roberts B, Neild P, Yalcin M, Allan P, FitzPatrick MEB, Gomez M, Williams S, Kok K, Sharkey L, Swift C, Mehta S, Naghibi M, Mountford C, Forbes A, Rahman F, Di Caro S. Nutritional care pathways in cancer patients with malignant bowel obstruction: A retrospective multi-centre study. Clin Nutr ESPEN 2024; 59:118-125. [PMID: 38220364 DOI: 10.1016/j.clnesp.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Variation in access to parenteral nutrition (PN) in patients with intestinal failure secondary to malignant bowel obstruction (MBO) exists due to differing practice, beliefs and resource access. We aimed to examine differences in nutritional care pathways and outcomes, by referral to nutrition team for PN in patients with MBO. METHODS This is a retrospective cohort study of MBO adults admitted to eight UK hospitals within a year and 1 year follow-up. Demographic, nutritional and medical data were analysed by comparing patients referred (R) or not referred (NR) for PN. Differences between groups were tested by Kruskal-Wallis, Chi-Squared tests and multi-level regression and survival using Cox regression. RESULTS 232 patients with 347 MBO admissions [median 66yr, (IQR: 55-74yrs), 67 % female], 79/232 patients were referred for PN (R group). Underlying primary malignancies of gynaecological and gastrointestinal origin predominated (71 %) and 78 % with metastases. Those in the NR group were found to be older, weigh more on admission, and more likely to be treated conservatively compared to those in the R group. For 123 (35 %) admissions, patients were referred to a nutrition team, and for 204 (59 %) admissions, patients were reviewed by a dietician. Multi-disciplinary team discussion and dietetic contact were more likely to occur in the R group-123/347 admissions (R vs NR group: 27 % vs. 7 %, P = 0.001; 95 % vs 39 %, P < 0.0001). Median admission weight loss was 8 % (IQR: 0 to 14). 43/123 R group admissions received inpatient PN only, with 32 patients discharged or already established on home parenteral nutrition. Overall survival was 150 days (126-232) with no difference between R/NR groups. CONCLUSION In this multi-centre study evaluating nutritional care management of patients with malignant bowel obstruction, only 1 in 3 admissions resulted in a referral to the nutrition team for PN, and just over half were reviewed by a dietician. Further prospective research is required to evaluate possible consequences of these differential care pathways on clinical outcomes and quality of life.
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Affiliation(s)
- Pinal S Patel
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; Cambridge Centre for Intestinal Rehabilitation and Transplant, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
| | - Konstantinos Fragkos
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; University College London, London, United Kingdom
| | - Niamh Keane
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; University College London, London, United Kingdom
| | - David Wilkinson
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | - Amy Johnson
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | - Derek Chan
- Intestinal Failure Unit, St Mark's and Northwick Park Hospital, London, United Kingdom
| | - Bradley Roberts
- Intestinal Failure Unit, St Mark's and Northwick Park Hospital, London, United Kingdom
| | - Penny Neild
- Department of Gastroenterology, St George's University Hospitals, London, United Kingdom
| | - Metin Yalcin
- Department of Gastroenterology, St George's University Hospitals, London, United Kingdom
| | - Philip Allan
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Michael E B FitzPatrick
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Michael Gomez
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Sarah Williams
- Department of Gastroenterology, St Bartholomew's Hospital, London, United Kingdom
| | - Klaartje Kok
- Department of Gastroenterology, St Bartholomew's Hospital, London, United Kingdom
| | - Lisa Sharkey
- Cambridge Centre for Intestinal Rehabilitation and Transplant, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Carla Swift
- Cambridge Centre for Intestinal Rehabilitation and Transplant, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Shameer Mehta
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; Department of Gastroenterology, St Bartholomew's Hospital, London, United Kingdom
| | - Mani Naghibi
- Intestinal Failure Unit, St Mark's and Northwick Park Hospital, London, United Kingdom
| | - Christopher Mountford
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | - Alastair Forbes
- Department of Gastroenterology, Norfolk & Norwich University Hospital, Norwich, United Kingdom; University of Tartu, Estonia
| | - Farooq Rahman
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; University College London, London, United Kingdom
| | - Simona Di Caro
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; University College London, London, United Kingdom
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