MON-P058: Can Patients be Independent of Total Parenteral Nutrition (TPN) after Intestinal Transplantation (ITX)

MON-P058: Can Patients be Independent of Total Parenteral Nutrition (TPN) after Intestinal Transplantation (ITX)

S174 Abnormally low magnesium, phosphate, zinc, selenium and copper levels were also found (11.6% (n = 17), 76% (n = 111), 5.5% (n = 8), 4.1% (n = 6),...

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S174 Abnormally low magnesium, phosphate, zinc, selenium and copper levels were also found (11.6% (n = 17), 76% (n = 111), 5.5% (n = 8), 4.1% (n = 6), 1.1% (n = 2), respectively,). PERT was prescribed for 43% of the cohort. FE-1 values and PERT prescriptions were poorly correlated (r2 < 0.01). Dietetic referral for these patients on PERT was poor (28.6%). Conclusion: This study highlighted the need for regular monitoring of PERT compliance, routine testing for nutritional markers, and structured dietetic involvement in PEI. Further research is required into the underlying reasons that prevent regular nutritional & PERT monitoring and dietetic involvement in PEI. Disclosure of Interest: None declared

MON-P056 AN AUDIT OF THE OUTCOMES OF SHORT BOWEL SYNDROME R. H. Gundogdu1, Y. Ozogul2, O. Yazicioglu1, B. O. Bozkirli3, S. Akbaba1. 1General Surgery, Ataturk Training and Research Hospital, 2Gastrointestinal Surgery, Yuksek Ihtisas Hospital, 3 General Surgery, Ankara Training and Research Hospital, Ankara, Turkey Rationale: Long-term nutritional management is life-saving therapy for patients with short bowel syndrome (SBS). However, indications and timing of these therapies are controversial. We evaluated the clinical condition and prognosis of our SBS cases to establish an algorithm for a treatment protocol. Methods: Seventy-two patients, each with <100 cm of small bowel (SB), were divided into three groups according to the length of the remnant: Group I (n = 30), colon plus 50–100 cm of SB; Group II (n = 23), colon plus <50 cm of SB; and Group III (n = 19), <50 cm of SB without colon. Results: One-year mortality rates for groups I, II, and III were 16.6%, 47.8%, and 100%, respectively. 94.4% of group I survivors developed intestinal adaptation, returning to regular oral feedings within 1 year. 75% of the surviving patients in group II developed adaptation and were fed the spesific oral short bowel diet we developed. None of the group III patients survived >1 year, mortality being due to multiorgan failure in the early postoperative period or from some infectious complications of long term parenteral nutrition. Five patients are in the home parenteral nutrition program. Conclusion: We created a treatment algorithm for SBS according to remnant length of the bowel after this audit. If the colon is intact, however, regardless of small bowel remnant length, a chance should be given to the patient to develop intestinal adaptation with careful nutritional management. Patients with a very short bowel may be candidates for intestinal transplantation when stable. References Pironi L, Arends J, Bozzetti F, et al.; Home Artificial Nutrition & Chronic Intestinal Failure Special Interest Group of ESPEN. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr. 2016 Apr;35(2):247– 307. Atalay F, Ozcay N, Gundogdu H, Orug T, Gungor A, Akoglu M. Evaluation of the outcomes of short bowel syndrome and indications for intestinal transplantation. Transplant Proc. 2003 Dec;35(8):3054–6. Disclosure of Interest: None declared

Poster MON-P057 POOR NUTRITIONAL STATUS AFFECTS HEALTH-RELATED QUALITY OF LIFE IN HOSPITALISED PATIENTS WITH CHRONIC LIVER DISEASE S. Marienfeld1, Y. Schmitt2, J. Bojunga1. 1Department of Internal Medicine 1, Division for Nutritional Medicine, Goethe-University Hospital Frankfurt, Frankfurt, 2 Department of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany Rationale: Patients with chronic liver disease (CLD) often suffer from malnutrition. Beside complications like pruritus, ascites, hepatic encephalopathy, gastrointestinal bleeding, and side-effects of medications as well as fatique, emotional distress, and worries may add to an impaired nutritional status and reduced health-related quality of life (HRQOL). We hypothesise that hospitalised patients with CLD and high risk for malnutrition show impaired score in Chronic Liver Disease Questionnaire German (CLDQ-D), indicating a reduced HRQOL. Methods: This prospective study includes in-patients with CLD admitted to our wards from April to August 2015. Anthropometric measurements, handgrip strength (HGS), body composition (bioelectric impedanz analysis), nutritional risk screening (NRS) and CLDQ-D are determined. Results: Overall 136 patients (95 men) mean age 59 years (21–82 years) were included. Among them 49 (36%) were at risk for malnutrition (NRS ≥ score 3). They showed lower body mass index, trizeps skinfold, mid-arm circumference, HGS, and phase angel (n. s.). HRQOL was significant lower in patients at risk for malnutrition: total score 4.3 ± 1.3 (at risk) vs 5.1 ± 1.1 (not at risk) (p < 0.001), abdominal symptoms 4.5 ± 1.8 vs 5.3 ± 1.5 ( p = 0.01), fatigue 3.5 ± 1.6 vs 4.4 ± 1.5 (p = 0.001), systemic symptoms 4.5 ± 1.4 vs 5.2 ± 1.3 ( p = 0.01), activity 3.9 ± 1.8 vs 5.4 ± 1.5 (p < 0.001), emotional function 4.5 ± 1.6 vs 5.4 ± 1.1 ( p = 0.005), and worry 4.6 ± 1.6 vs 5.2 ± 1.2 (p = 0.03). Conclusion: Patients at risk for malnutrition show impaired HRQOL. Further studies are required to investigate the effect of nutritional therapy on HRQOL. Disclosure of Interest: None declared

MON-P058 CAN PATIENTS BE INDEPENDENT OF TOTAL PARENTERAL NUTRITION (TPN) AFTER INTESTINAL TRANSPLANTATION (ITX) S. Tabak1, H. Noordhoff1, G. Dijkstra1. 1Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, Netherlands Rationale: Is intestinal transplantation a successful treatment of Chronic Intestinal Failure (CIF) to become independent of TPN); results of 10 adult transplantations at the University Medical Centre Groningen. Methods: Ten patients (8 female, 2 male) aged 24–55 years, with chronic intestinal failure after intestinal transplantation. Retrospective observational study from September 2001 to March 2016. Results: At the University Medical Centre Groningen 15 patients are screened for ITX. Since 2001 ten intestinal transplantations were carried out in nine adult patient with CIF. Reasons for transplantation were short bowel syndrome, motility disorder, line occlusion and infection, liverdisease,

Liver and gastrointestinal tract 2 bad quality of life. They were hospitalized for 20–108 days. All patients stopped with TPN within 9–57 days. Tube feeding was started after 2–11 days and stopped within 11–130 days. A clear liquid diet was started within 2–11 days and 1 regular diet was introduced median 18 days after ITX. Afterwards 2 patients died, 2 patients had rejection of the graft, which had to be removed; 6 patients had a regular diet, but needed supplementary magnesium and iron. Conclusion: After ITX no patients were independent of TPN. All patients had a regular diet, but needed supplementary minerals and trace-elements. References Roskott A.M., Intestinal Failure and transplantation, penny wise – pound foolish, 2014 Pironi L., et al., ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults, Clinical Nutrition 34 (2015) Disclosure of Interest: None declared

MON-P059 INFLUENCES OF NUTRITIONAL ROUTE ON KUPFFER CELL PHAGOCYTIC FUNCTION S. Murakoshi1, K. Fukatsu1, M. Noguchi1, M. Ri2, T. Watanabe3, E. Tominaga1, T. Moriya3, H. Yasuhara1. 1Surgical Center, 2 Department of Gastrointestinal Surgery, The University of Tokyo Hospital, Tokyo, 3Department of Surgery, National Defense Medical College, Tokorozawa, Japan Rationale: Total parenteral nutrition (TPN) is essential for the prevention of progressive malnutrition when enteral delivery of nutrients is not applicable. Experimentally, lack of enteral nutrition impairs the function of cytokine production by hepatic mononuclear cells (MNCs), leading to increased susceptibility to infectious complication. However, the influence of nutritional route on phagocytic activity of hepatic macrophage (Kupffer cell) is not clarified. Herein, we examined how the nutrition route affects phagocytic activity of Kupffer cells with a murine nutrition model. Methods: Male ICR mice (n = 33) were randomized to standard parenteral nutrition (PN) or Control group. After jugular vein catheter insertion, the PN group was advanced from 7.2 mL/ day PN solution to a target rate of 12.0 mL/day by the third day of feeding (day 1, 0.3 mL/hr; day 2, 0.4 mL/hr, days 3–5, 0.5 mL/hr). The Control group received normal saline infusion with free access to chow. After five days of respective diet, hepatic MNCs (including Kupffer cells) were isolated. Hepatic MNCs and microsphere were incubated with or without lipopolysaccharide (LPS) in vitro. Microsphere phagocytosis by Kupffer cells was evaluated using flowcytometry. Results: Without lipopolysaccharide (LPS) stimulation, there were no significant differences in the ratio of Kupffer cells which phagocytized one or more microspheres between the two groups. However, the ratio was significantly lower in the PN than in the Control group with LPS stimulation (unpaired t-test, p < 0.01, mean±SE, PN:64.1 ± 2.4% vs Control:72.5 ± 1.5%). Conclusion: Lack of enteral nutrition may decrease phagocytic activity of Kupffer cell with LPS stimulation, leading to impaired hepatic immunity. Disclosure of Interest: None declared

S175 MON-P060 IMPACT OF SKELETAL MUSCLE MASS, MUSCLE QUALITY, AND VISCERAL ADIPOSITY ON OUTCOMES FOLLOWING RESECTION OF INTRAHEPATIC CHOLANGIOCARCINOMA S. Okumura1, T. Kaido1, Y. Hamaguchi1, A. Kobayashi1, H. Shirai1, S. Yagi1, H. Okajima1, S. Uemoto1. 1Division of Hepato-Biliary-Pancreatic surgery and Transplantation, Kyoto University, Kyoto, Japan Rationale: Decrease in skeletal muscle mass and function, known as sarcopenia, is associated with poor prognosis. Visceral fat accumulation is also related to mortality. This study investigated the impact of preoperative skeletal muscle mass, muscle quality, and visceral adiposity on outcomes in patients undergoing resection of intrahepatic cholangiocarcinoma (ICC). Methods: A retrospective analysis was performed of 109 patients undergoing resections of ICC between January 2004 and April 2015. Skeletal muscle mass [skeletal muscle index (SMI)], skeletal muscle quality [muscle attenuation (MA)], and visceral adiposity [visceral to subcutaneous adipose tissue area ratio (VSR)] were measured on preoperative computed tomography images. Overall survival (OS) and recurrence-free survival (RFS) rates were compared according to these factors, and prognostic factors after resection were assessed. Results: OS rates were significantly lower in patients with low SMI ( p = 0.002), low MA ( p = 0.032), and high VSR ( p = 0.026) compared with patients with high SMI, high MA, and low VSR, respectively. RFS rates were significantly lower in patients with low SMI ( p = 0.015) and high VSR ( p = 0.049) compared with those with high SMI and low VSR, respectively. Multivariate=analysis revealed that low SMI (Hazard ratio [HR] = 3.19, 95% confidence interval (CI) = 1.70–6.37, p < 0.001) and low MA (HR = 3.53, 95% CI = 1.84–6.97, p < 0.001) were independent predictors of poor survival together with advanced stage and multiple tumors. Conclusion: Low skeletal muscle mass, low muscle quality, and visceral adiposity are closely related to mortality after resection of ICC. Disclosure of Interest: None declared

MON-P061 INFLUENCES OF AD LIBITUM FEEDING OF A LOW CARBOHYDRATE-HIGH FAT DIET ON HOST RESPONSE TO GUT ISCHEMIA REPERFUSION IN MICE T. Watanabe1,2, K. Fukatsu1, S. Murakoshi1, T. Moriya2, M. Lee3, H. Ueno2, J. Yamamoto2, K. Hase2, H. Yasuhara1. 1Surgical Center, The University of Tokyo Hospital, Tokyo, 2Surgery, National Defense Medical College, Tokorozawa City, 3 Gastrointestinal Surgery, The University of Tokyo Hospital, Tokyo, Japan Rationale: Low carbohydrate-high fat diets (LCHFDs) reportedly reduce the risk of metabolic syndrome. However, whether LCHFDs are also beneficial in terms of the host response to surgical insults is controversial. We previously demonstrated LCHFD, as compared with normal diet, feeding to improve survival at early time points after gut I/R in mice. However, the mechanism underlying this improvement remains unclear. Herein, to clarify this mechanism, we evaluated the influences of LCHFD on adipocytokine levels, anti-oxidative capacity and organ injury.