{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:35:49Z","timestamp":1792798549814,"version":"4.5.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2020,4,18]],"date-time":"2020-04-18T00:00:00Z","timestamp":1587168000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"NZ Medical Technologies Centre of Research Excellence"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,7,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>High-output enterostomies and enteroatmospheric fistulas are common causes of intestinal failure, and may necessitate parenteral nutrition and prolonged hospital stay. Reinfusing lost chyme into the distal gut is known to be beneficial, but implementation has been limited because manual reinfusion is unpleasant and labour-intensive, and no devices are available. A new device is presented for reinfusing chyme easily and efficiently, with first-in-human data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The device comprises a compact centrifugal pump that fits inside a standard stoma appliance. The pump is connected to an intestinal feeding tube inserted into the distal intestinal limb. The pump is activated across the appliance by magnetic coupling to a hand-held driver unit, effecting intermittent bolus reinfusion while avoiding effluent contact. Safety, technical and clinical factors were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Following microbiological safety testing, the device was evaluated in ten patients (median duration of installation 39\u00b75 days; total 740 days). Indications included remediation of high-output losses (8 patients), dependency on parenteral nutrition (5), and gut rehabilitation before surgery (10). Reinfusion was well tolerated with use of regular boluses of approximately 200 ml, and no device-related serious adverse events occurred. Clinical benefits included resumption of oral diet, cessation of parenteral nutrition (4 of 5 patients), correction of electrolytes and liver enzymes, and hospital discharge (6 of 10). Of seven patients with intestinal continuity restored, one experienced postoperative ileus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A novel chyme reinfusion device was developed and found to be safe, demonstrating potential benefits in remediating high-output losses, improving fluid and electrolyte balance, weaning off parenteral nutrition and improving surgical recovery. Pivotal trials and regulatory approvals are now in process.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bjs.11516","type":"journal-article","created":{"date-parts":[[2020,4,18]],"date-time":"2020-04-18T05:16:17Z","timestamp":1587186977000},"page":"1199-1210","source":"Crossref","is-referenced-by-count":37,"title":["Novel chyme reinfusion device for gastrointestinal fistulas and stomas: feasibility study"],"prefix":"10.1093","volume":"107","author":[{"given":"P","family":"Sharma","sequence":"first","affiliation":[{"name":"Department of Surgery , Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Davidson","sequence":"additional","affiliation":[{"name":"The Insides Company , Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Davidson","sequence":"additional","affiliation":[{"name":"The Insides Company , Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Keane","sequence":"additional","affiliation":[{"name":"Department of Surgery , Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Surgery , Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S R","family":"Ritchie","sequence":"additional","affiliation":[{"name":"Infection and Immunity, University of Auckland , Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Chu","sequence":"additional","affiliation":[{"name":"The Insides Company , Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Sutherland","sequence":"additional","affiliation":[{"name":"The Insides Company , Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I P","family":"Bissett","sequence":"additional","affiliation":[{"name":"Department of Surgery , Auckland, New Zealand"},{"name":"The Insides Company , Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5998-1080","authenticated-orcid":false,"given":"G","family":"O'Grady","sequence":"additional","affiliation":[{"name":"Department of Surgery , Auckland, New Zealand"},{"name":"The Insides Company , Auckland, New Zealand"},{"name":"Auckland Bioengineering Institute , Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,4,18]]},"reference":[{"key":"2022100812523297500_bjs11516-bib-0001","doi-asserted-by":"crossref","first-page":"1646","DOI":"10.1002\/bjs.4788","article-title":"An 11-year experience of enterocutaneous fistula","volume":"91","author":"Hollington","year":"2004","journal-title":"Br J Surg"},{"key":"2022100812523297500_bjs11516-bib-0002","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1055\/s-0037-1598163","article-title":"Management of intestinal failure: the high-output enterostomy and enterocutaneous fistula","volume":"30","author":"Adaba","year":"2017","journal-title":"Clin Colon Rectal Surg"},{"key":"2022100812523297500_bjs11516-bib-0003","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s12937-015-0034-z","article-title":"Protocol for the detection and nutritional management of high-output stomas","volume":"14","author":"Arenas Villafranca","year":"2015","journal-title":"Nutr J"},{"key":"2022100812523297500_bjs11516-bib-0004","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1002\/bjs.5396","article-title":"Nutrition and management of enterocutaneous fistula","volume":"93","author":"Lloyd","year":"2006","journal-title":"Br J Surg"},{"key":"2022100812523297500_bjs11516-bib-0005","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/j.clnu.2016.04.020","article-title":"Chyme reinfusion in patients with intestinal failure due to temporary double enterostomy: a 15-year prospective cohort in a referral centre","volume":"36","author":"Picot","year":"2017","journal-title":"Clin Nutr"},{"key":"2022100812523297500_bjs11516-bib-0006","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1097\/MCO.0000000000000304","article-title":"Chyme reinfusion or enteroclysis in nutrition of patients with temporary double enterostomy or enterocutaneous fistula","volume":"19","author":"Thibault","year":"2016","journal-title":"Curr Opin Clin Nutr Metab Care"},{"key":"2022100812523297500_bjs11516-bib-0007","article-title":"Chyme reinfusion for high-output stomas and enterocutaneous fistulas in adult patients: a systematic review","author":"Bhat","year":"2019","journal-title":"Nutr Clin Pract"},{"key":"2022100812523297500_bjs11516-bib-0008","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1097\/01.mpg.0000228111.21735.02","article-title":"What is the evidence on the practice of mucous fistula refeeding in neonates with short bowel syndrome?","volume":"43","author":"Richardson","year":"2006","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"2022100812523297500_bjs11516-bib-0009","first-page":"28","article-title":"Restoring gut continuity: reinfusion of effluent via distal limb of a loop jejunostomy","volume":"36","author":"Kittscha","year":"2016","journal-title":"WCET J"},{"key":"2022100812523297500_bjs11516-bib-0010","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/j.jpedsurg.2012.07.064","article-title":"Recycling of bowel content: the importance of the right timing","volume":"48","author":"Pataki","year":"2013","journal-title":"J Pediatr Surg"},{"key":"2022100812523297500_bjs11516-bib-0011","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1177\/004947550003000308","article-title":"Postoperative small bowel fistula: back to basics","volume":"30","author":"Bissett","year":"2000","journal-title":"Trop Doct"},{"key":"2022100812523297500_bjs11516-bib-0012","first-page":"430","article-title":"Is jejunostomy output nutrient or waste in short bowel syndrome? Experience from six cases","volume":"25","author":"Liu","year":"2016","journal-title":"Asia Pac J Clin Nutr"},{"key":"2022100812523297500_bjs11516-bib-0013","doi-asserted-by":"crossref","first-page":"1751","DOI":"10.3390\/toxins2071751","article-title":"Food poisoning and Staphylococcus aureus enterotoxins","volume":"2","author":"Argud\u00edn","year":"2010","journal-title":"Toxins (Basel)"},{"key":"2022100812523297500_bjs11516-bib-0014","doi-asserted-by":"crossref","first-page":"461","DOI":"10.7326\/0003-4819-130-6-199903160-00002","article-title":"A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group","volume":"130","author":"Levey","year":"1999","journal-title":"Ann Intern Med"},{"key":"2022100812523297500_bjs11516-bib-0015","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1097\/SLA.0b013e318293ee55","article-title":"Identification of clinical outcome measures for recovery of gastrointestinal motility in postoperative ileus","volume":"259","author":"van Bree","year":"2014","journal-title":"Ann Surg"},{"key":"2022100812523297500_bjs11516-bib-0016","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1007\/s11605-013-2148-y","article-title":"Defining postoperative ileus: results of a systematic review and global survey","volume":"17","author":"Vather","year":"2013","journal-title":"J Gastrointest Surg"},{"key":"2022100812523297500_bjs11516-bib-0017","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1002\/bjs.1800750615","article-title":"Continuous enteral nutrition during the early adaptive stage of the short bowel syndrome","volume":"75","author":"Levy","year":"1988","journal-title":"Br J Surg"},{"key":"2022100812523297500_bjs11516-bib-0018","first-page":"782","article-title":"Continuous reinstillation of chyme in digestive resuscitation: demonstration of negative retro-action on the digestive secretion output","volume":"8","author":"Levy","year":"1979","journal-title":"Nouv Presse Med"},{"key":"2022100812523297500_bjs11516-bib-0019","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1097\/00000658-198311000-00006","article-title":"Inhibition of upper gastrointestinal secretions by reinfusion of succus entericus into the distal small bowel. A clinical study of 30 patients with peritonitis and temporary enterostomy","volume":"198","author":"L\u00e9vy","year":"1983","journal-title":"Ann Surg"},{"key":"2022100812523297500_bjs11516-bib-0020","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.clnu.2009.08.010","article-title":"Plasma citrulline is a marker of absorptive small bowel length in patients with transient enterostomy and acute intestinal failure","volume":"29","author":"Picot","year":"2010","journal-title":"Clin Nutr"},{"key":"2022100812523297500_bjs11516-bib-0021","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1007\/s11605-018-3752-7","article-title":"Distal bowel re-feeding in patients with proximal jejunostomy","volume":"22","author":"Nagar","year":"2018","journal-title":"J Gastrointest Surg"},{"key":"2022100812523297500_bjs11516-bib-0022","volume-title":"Breakthrough Devices Programme","author":"US Food and Drug Administration","year":"2019"},{"key":"2022100812523297500_bjs11516-bib-0023","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1002\/bjs.4520","article-title":"Fistuloclysis can successfully replace parenteral feeding in the nutritional support of patients with enterocutaneous fistula","volume":"91","author":"Teubner","year":"2004","journal-title":"Br J Surg"},{"key":"2022100812523297500_bjs11516-bib-0024","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.clnu.2014.08.017","article-title":"Home Artificial Nutrition & Chronic Intestinal Failure; Acute Intestinal Failure Special Interest Groups of ESPEN. ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults","volume":"34","author":"Pironi","year":"2015","journal-title":"Clin Nutr"},{"key":"2022100812523297500_bjs11516-bib-0025","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1097\/DCR.0b013e31823d0ec5","article-title":"Dehydration is the most common indication for readmission after diverting ileostomy creation","volume":"55","author":"Messaris","year":"2012","journal-title":"Dis Colon Rectum"},{"key":"2022100812523297500_bjs11516-bib-0026","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1097\/SLA.0000000000001683","article-title":"Readmission after ileostomy creation: retrospective review of a common and significant event","volume":"265","author":"Fish","year":"2017","journal-title":"Ann Surg"},{"key":"2022100812523297500_bjs11516-bib-0027","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1007\/s00384-010-1086-3","article-title":"Renal impairment caused by temporary loop ileostomy","volume":"26","author":"Beck-Kaltenbach","year":"2011","journal-title":"Int J Colorectal Dis"},{"key":"2022100812523297500_bjs11516-bib-0028","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1097\/SLA.0000000000001829","article-title":"Early closure of a temporary ileostomy in patients with rectal cancer: a multicenter randomized controlled trial","volume":"265","author":"Danielsen","year":"2017","journal-title":"Ann Surg"},{"key":"2022100812523297500_bjs11516-bib-0029","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1097\/DCR.0000000000000531","article-title":"Effect of diversion ileostomy on the occurrence and consequences of chemotherapy-induced diarrhea","volume":"59","author":"Robertson","year":"2016","journal-title":"Dis Colon Rectum"},{"key":"2022100812523297500_bjs11516-bib-0030","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1007\/s11605-014-2679-x","article-title":"Anterior resection syndrome\u2014a risk factor analysis","volume":"19","author":"Wells","year":"2015","journal-title":"J Gastrointest Surg"},{"key":"2022100812523297500_bjs11516-bib-0031","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1002\/bjs.11092","article-title":"Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer","volume":"106","author":"Keane","year":"2019","journal-title":"Br J Surg"},{"key":"2022100812523297500_bjs11516-bib-0032","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1111\/codi.14636","article-title":"Preoperative bowel stimulation prior to ileostomy closure to restore bowel function more quickly and improve postoperative outcomes: a systematic review","volume":"21","author":"Rombey","year":"2019","journal-title":"Colorectal Dis"},{"key":"2022100812523297500_bjs11516-bib-0033","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1097\/DCR.0000000000000237","article-title":"Stimulation of the efferent limb before ileostomy closure: a randomized clinical trial","volume":"57","author":"Abrisqueta","year":"2014","journal-title":"Dis Colon Rectum"}],"container-title":["British Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fbjs.11516","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/bjs\/article-pdf\/107\/9\/1199\/46388578\/bjs11516.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjs\/article-pdf\/107\/9\/1199\/46388578\/bjs11516.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,8]],"date-time":"2022-10-08T09:28:14Z","timestamp":1665221294000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjs\/article\/107\/9\/1199\/6120698"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,18]]},"references-count":33,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,4,18]]},"published-print":{"date-parts":[[2020,7,21]]}},"URL":"https:\/\/doi.org\/10.1002\/bjs.11516","relation":{},"ISSN":["0007-1323","1365-2168"],"issn-type":[{"value":"0007-1323","type":"print"},{"value":"1365-2168","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,8]]},"published":{"date-parts":[[2020,4,18]]}}}