Distal Enteral Feeding: A Comprehensive Review and Practical Guidance

Abstract

Enterocutaneous fistula and high output stomas are common causes of type 2 intestinal failure in which parenteral support remains the gold standard management for nutritional, fluid, and electrolyte losses. However, parenteral support is associated with significant morbidity and mortality, such as infection and liver dysfunction, as well as high cost. In cases where the distal bowel limb is accessible, distal enteral feeding (DEF) represents a logical therapeutic solution to remediate these losses, and thus minimize patients’ dependency on parenteral nutrition. Studies have demonstrated how DEF can reduce stoma output, decrease reliance on parenteral nutrition, and improve renal and liver function. DEF can also be performed prior to bowel continuity surgery in patients with a double barrel enterostomy to improve gut function and enhance surgical recovery. Despite the potential benefits, DEF has not been widely adopted due to lack of training and experience, as well as poor tolerance amongst both patients and staff. The recent development of a novel chyme reinfusion device has a potential to make DEF more accessible. This narrative review aims to provide a summary of the therapeutic uses of DEF and a practical guidance for its clinical application, as well as to discuss future research directions.