Details

Autor(en) / Beteiligte

• Stoop, Thomas F.
• Bodegraven, Eduard A.
• ten Haaft, Britte H. E. A.
• Etten‐Jamaludin, Faridi S.
• Zundert, Suzanne M. C.
• Lambe, Cécile
• Tabbers, Merit M.
• Gorter, Ramon R.

Titel

Systematic review on management of high‐output enterostomy in children: An urgent call for evidence

Ist Teil von

• Journal of pediatric gastroenterology and nutrition, 2024-02, Vol.78 (2), p.188-196

Ort / Verlag

United States

Erscheinungsjahr

2024

Quelle

Wiley-Blackwell Journals

Beschreibungen/Notizen

• Objectives/Background High‐output stoma is one of the most common major morbidities in young children with an enterostomy that could lead to intestinal failure. Management of high‐output enterostomy in children is mostly based on personal experience. This systematic review aims to clarify the evidence‐based therapeutic approach of high‐output enterostomy in children. Methods A systematic review was performed using Pubmed, Embase (Ovid), and Cochrane Library to identify studies published until March 20, 2023, following the 2020 Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guideline. The study population comprised children (i.e., age <18 years) with high‐output enterostomy (i.e., jejuno‐, ileo‐, and/or colostomy), regardless of underlying aetiology. Interventions comprised any (non)pharmacological and/or surgical treatment. Interventions were compared with each other, placebos, and/or no interventions. Primary outcome was reduction of enterostomy output. Secondary outcomes were morbidity, mortality, quality of life, associated healthcare costs, and adverse events. Results The literature search identified 4278 original articles of which 366 were screened on full text, revealing that none of the articles met the inclusion criteria. Conclusion This first systematic review on management of high‐output enterostomy in children revealed that any evidence on the primary and secondary outcomes is lacking. There is an urgent need for evidence on conservative treatment strategies including fluid restrictions, dietary advices, oral rehydration solution, chyme re‐infusion, and pharmacological and surgical treatments of high‐output enterostomy in children, aiming to reduce the risk for short‐ and long‐term complications. Till more evidence is available, a systematic and multidisciplinary step‐up approach is needed. Therefore, a therapeutic work‐up is proposed that could guide the care. This systematic review revealed the urgent need for evidence on conservative, pharmacological, and surgical treatment strategies for children with high‐output enterostomy. Till more evidence is available, a systematic and multidisciplinary step‐up approach is needed to avoid short‐ and long‐term complications. Therefore, a therapeutic work‐up is proposed here that could guide the care. What Is Known High‐output enterostomy is one of the most common major morbidities in young children with an enterostomy that could lead to intestinal failure. Management of high‐output enterostomy in children is mostly based on personal experience instead of an evidence‐based approach. What Is New Any evidence about management of high‐output enterostomy in children is missing. There is an urgent need for evidence on treatment strategies. Till more evidence is available, a systematic and multidisciplinary step‐up approach is needed for these vulnerable patients. Therefore, a therapeutic work‐up is proposed that could guide the care.