Enteral Autonomy with Teduglutide Treatment of Intestinal Failure/Short Bowel Syndrome with Depleted Central Venous Access

Excerpt

Intestinal failure (IF) occurs when there is reduction in functioning gut mass below the minimum necessary for adequate digestion and absorption of nutrients, and patients require enteral or intravenous supplementation [1, 2]. Patients requiring long-term parenteral nutrition (PN) are at risk of recurrent central venous catheter (CVC) complications that can lead to loss of central access, an important indication for intestinal transplantation (IT) [3]. In spite of improvements in IT, 5-year graft survival ranges from 37.2 to 62.3% [4]. Other options are needed for IF-short bowel syndrome (SBS) patients with loss of CVC access. In 2012, teduglutide, a glucagon-like peptide-2 (GLP-2), analogue was approved by the US Food and Drug Administration (FDA) “for the treatment of adult patients with SBS who are dependent on parenteral support” to reduce PN dependence [5]. In the European Union, it is indicated for “treatment of patients aged 1 year and above with SBS… stable following a period of intestinal adaptation after surgery.” Herein, we describe its use to achieve enteral autonomy in a patient with IF-SBS and no remaining standard CVC access. We adhered to institutional review board guidelines, and written informed consent was obtained from the patient’s legal guardian for this report. …