Short Bowel Syndrome When Teduglutide or Bowel-Lengthening Surgery Did Not Achieve Enteral Autonomy

This protocol applies to patients with short bowel syndrome‑associated intestinal failure who have already received an optimised first-line regimen but did not reach the primary therapeutic goal of weaning from parenteral nutrition.

Prior Treatment — What Was Tried and What Was Not Achieved

The preceding line included teduglutide (Gattex) by daily subcutaneous injection, and/or non-transplant autologous gastrointestinal reconstructive surgery — specifically the LILT/Bianchi operation or the serial transverse enteroplasty (STEP) procedure — together with restoration of intestinal continuity and recruitment of available distal bowel. Despite these interventions, the goal of improved intestinal absorptive function with weaning from parenteral nutrition, including achievement of enteral autonomy, was not met. This protocol defines the escalation step following that documented failure.

Next-Line Approach — Partial Overview

For patients with intestinal failure in whom parenteral nutrition support has become untenable, the next clinical pathway centres on a surgical transplantation approach. The specific criteria for referral, patient selection, and the conditions under which an additional concurrent procedure may be required are defined in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.cgh.2022.05.032

The Centers for Medicare and Medicaid Services recommends intestinal transplantation (ITX) consideration for patients with IF (ie, refractory PN dependency) and onset of PN failure.

It is important that patients with SBS-IF experiencing PN complications are referred early for ITX consideration.

View source ↗