Method of Gouttebel et al for Predicting Duration of Total Parenteral Nutrition in Patients with Short Bowel Syndrome

Description

Gouttebel et al identified findings in patients with the short bowel syndrome that predict the probable duration required for total parenteral nutrition (TPN). They identified a correlation between the length of residual small bowel and the necessary duration of nutritional support. The authors are from the Cancer Institute in Montepellier, France.

NOTE: According to Gray's Anatomy (page 1763 in the 38th Edition, 1995) the small intestine ranges from 3.35 to 7.16 meters in women and 4.88 to 7.85 meters in men.

Parameters:

(1) length of small bowel remnant

(2) presence/absence of colon remnant

(3) presence/absence of colon remnant

Small Bowel Remnant in centimeters	Colon Remnant	Rectum Remnant	Group	Duration of TPN
50 – 70 cm	present	present	A	1-6 months
80 – 150 cm	present or absent	present or absent	A	1-6 months
40 – 70 cm	half (partial)	present	B	6-12 months
10 – 30 cm	present or absent	present or absent	C	permanent
< 60 cm	absent	absent	C	permanent

after Table 2, page 722

where:

• In the implementation I had the first entry for group A as 50 – 80 cm and group B from 40 – 80 cm. This is to cover the gap from 70-80 cm.

Subgroup for Group A	Finding	Intestinal Adaptation
A1	no colectomy	fairly rapid (< 3 months)
A2	partial or total colectomy	more prolonged

If the length of the small bowel was > 150 cm, the duration for TPN was less than 2 weeks.

Chemotherapy is toxic to intestinal epithelium and retards intestinal adaptation.

Limitations:

• With improved nutritional support since 1986 it may be possible to reduce the amount of time required for TPN.

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Method of Gouttebel et al for Predicting Duration of Total Parenteral Nutrition in Patients with Short Bowel Syndrome

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