Malabsorption in Short Bowel Syndrome: When GLP-2 Analogue Therapy Has Not Achieved Adequate Reduction in Parenteral Volume
Clinical scenario
This protocol addresses patients with intestinal failure due to short bowel syndrome (SBS) who require parenteral fluids or nutrients, have completed the period of intestinal adaptation, and in whom an initial course of GLP-2 analogue treatment has not produced a sufficient, sustained reduction in parenteral support.
Previous treatment — failure condition
Prior therapy: Glucagon-like peptide 2 (GLP-2) analogue (teduglutide), initiated to reduce or withdraw parenteral support in patients stable after postoperative intestinal adaptation.
Goals not reached: A stable 20% reduction in intravenous volume from baseline — while maintaining stable body weight and composition, electrolyte balance, and renal function — was not achieved or sustained.
This protocol represents the structured next step after that failure.
Next-step approach (partial overview)
After failure of GLP-2 analogue therapy, the evidence-based approach for this situation involves non-transplant surgical intervention — procedures aimed at restoring or maximising functional intestinal surface area in appropriately selected patients. More than one surgical strategy may be relevant depending on individual anatomy.
The full protocol — including patient selection criteria, specific procedure options, sequencing, and goals — is available via the complete structured regimen below.
References
- The use of glucagon-like peptide 2 (GLP-2) analogues (e.g., teduglutide) is recommended for patients with intestinal failure due to short bowel syndrome who require parenteral fluids or nutrients after the period of intestinal adaptation, in order to reduce or withdraw parenteral support and improve quality of life.
- In patients with SBS who have an ostomy, bowel continuity should be restored whenever possible, to reduce home PN dependency.
- Once the patient is stabilized, reconstruction of gastrointestinal continuity should be prioritized whenever feasible by ostomy reversal and recruitment of distal bowel.
- Bowel lengthening procedures may be considered in selected patients.
- Tapering techniques without loss of surface area are achieved by both with the longitudinal intestinal lengthening and tailoring (LILT), and the serial transverse enteroplasty (STEP) procedure.
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