欧洲肠外肠内营养学会（ESPEN）成人慢性肠衰竭指南

　　2016年4月，欧洲肠外肠内营养学会（ESPEN）在《临床营养》（Clinical Nutrition）杂志正式发表了成人慢性肠衰竭指南，全文共60页！

　　慢性肠衰竭管理需要复杂的技术以及多学科多专业人员的共同参与。指南关于成人慢性肠衰竭管理的相关问题共提出了112条推荐意见，其中多数推荐意见的证据质量为低级，约有2/3的推荐意见为强推荐。

Clin Nutr. 2016 Apr;35(2):247-307.

ESPEN guidelines on chronic intestinal failure in adults.

Pironi L, Arends J, Bozzetti F, Cuerda C, Gillanders L, Jeppesen PB, Joly F, Kelly D, Lal S, Staun M, Szczepanek K, Van Gossum A, Wanten G, Schneider SM; Home Artificial Nutrition & Chronic Intestinal Failure Special Interest Group of ESPEN.

  • St. Orsola-Malpighi University Hospital, Bologna, Italy.

  • University of Freiburg, Germany.

  • University of Milan, Milan, Italy.

  • Hospital General Universitario Gregorio Maranón, Madrid, Spain.

  • Auckland City Hospital, (AuSPEN) Auckland, New Zealand.

  • Rigshospitalet, Copenhagen, Denmark.

  • Hopital Beaujon, Clichy, France.

  • Mayo Clinic College of Medicine, Rochester, MN, USA.

  • Oley Foundation for Home Parenteral and Enteral Nutrition, Albany, NY, USA.

  • Salford Royal Foundation Trust, Salford, UK.

  • Stanley Dudrick's Memorial Hospital, Skawina, Poland.

  • Hopital Erasme, Free University of Brussels, Belgium.

  • Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

  • CHU of Nice, University of Nice Sophia Antipolis, Nice, France.

BACKGROUND & AIMS: Chronic Intestinal Failure (CIF) is the long-lasting reduction of gut function, below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth. CIF is the rarest organ failure. Home parenteral nutrition (HPN) is the primary treatment for CIF. No guidelines (GLs) have been developed that address the global management of CIF. These GLs have been devised to generate comprehensive recommendations for safe and effective management of adult patients with CIF.

METHODS: The GLs were developed by the Home Artificial Nutrition & Chronic Intestinal Failure Special Interest Group of ESPEN. The GRADE system was used for assigning strength of evidence. Recommendations were discussed, submitted to Delphi rounds, and accepted in an online survey of ESPEN members.

RESULTS: The following topics were addressed: management of HPN; parenteral nutrition formulation; intestinal rehabilitation, medical therapies, and non-transplant surgery, for short bowel syndrome, chronic intestinal pseudo-obstruction, and radiation enteritis; intestinal transplantation; prevention/treatment of CVC-related infection, CVC-related occlusion/thrombosis; intestinal failure-associated liver disease, gallbladder sludge and stones, renal failure and metabolic bone disease. Literature search provided 623 full papers. Only 12% were controlled studies or meta-analyses. A total of 112 recommendations are given: grade of evidence, very low for 51%, low for 39%, moderate for 8%, and high for 2%; strength of recommendation: strong for 63%, weak for 37%.

CONCLUSIONS: CIF management requires complex technologies, multidisciplinary and multiprofessional activity, and expertise to care for both the underlying gastrointestinal disease and to provide HPN support. The rarity of the condition impairs the development of RCTs. As a consequence, most of the recommendations have a low or very low grade of evidence. However, two-thirds of the recommendations are considered strong. Specialized management and organization underpin these recommendations.

PMID: 26944585

DOI: 10.1016/j.clnu.2016.01.020

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