60 Poster presentations

PP095OPERATIVE AND LONG-TERM OUTCOME OF CHRONICRADIATION ENTERITIS WITH SHORT BOWEL SYNDROMEIN A COHORT OF 108 PATIENTS, AFTER LARGEINTESTINAL RESECTIONA. Amiot1, F. Joly1, J.H. Lefevre2, O. Corcos1,F. Bretagnol2, Y. Bouhnik1, Y. Panis2, B. Messing1.1Gastroenterologie et Assistance Nutritive, 2ChirurgieColorectale, CHU Beaujon, Clichy, France

Rationale: The management of chronic radiation enteritis(CRE) is controversial when considering large bowelresection and its consequences, i.e. postoperative mor-bidity, short bowel syndrome (SBS) and home parenteralnutrition (HPN).Methods: 108 CRE patients with SBS, i.e. <200 cm(95F, median age 56.6 (22 95)yrs) were followed up atour institution since 1980. Survival, HPN dependenceand reoperation rates were studied with Kaplan-Meiermethod, log-rank test and Cox model.Results: Follow-up was 4.8 (0.1 22)yrs. Global mortalitywas 48%, in which HPN-related mortality was 4%. Postop-erative morbidity occurred in 71%: Grade 1 (20% per pro-cedure), 2 (25%), 3 (20%), 4 (4%) and 5 (2%), according toDindo classification. Survival probabilities were 93%, 67%,and 44% percent at 1, 5 and 10 yrs, respectively. Survivalwas decreased with active neoplasia (RR 0.28; 0.16 0.51),ASA score >3 (RR 0.44; 0.24 0.82) and age >60 yrs (RR0.52; 0.28 0.96). HPN dependence probabilities were 66%and 42%, at 1 and 3 yrs, respectively. HPN dependencewas decreased with remnant small bowel length >100 cm(RR 0.35; 0.18 0.67), adaptive hyperphagia (RR 0.39;0.17 0.86) and absence of end enterostomy (RR 0.47;0.27 0.83). Reoperation probabilities were 44% and 59%,at 1 and 5 yrs, respectively. Reoperation was increasedwith anastomotic leakage (RR 3.4; 1.7 6.7), intra-operative small bowel injury (RR 2.7; 1.3 5.6) andemergency procedure (RR 2.4; 1.3 4.3) and decreasedwith ileocolonic resection if terminal ileum was involved(RR 0.16; 0.1 0.3).Conclusion: Survival of CRE patients after large intestinalresection is good, mainly influenced by underlyingcomorbidities. HPN is a safe therapy with more than50 of weaning off. Reoperation rate and postoperativemorbidity is high and should be prevent by scheduledprocedure and ileocolonic resection when terminal ileumis involved.

Disclosure of Interest: None declared

PP096A STUDY OF ORAL HEALTH IN INTESTINAL FAILUREPATIENTS RECEIVING HOME PARENTERAL NUTRITIONA.M. Lee1, S.M. Gabe2, J.M. Nightingale3, J. Fiske4,M. Burke5. 1Clinical Fellow, Department of Oral andMaxillofacial Surgery, North West London Hospitals, NHSTrust, 2Consultant Gastroenterologist & Co-Chair of theLennard-Jones Intestinal Failure Unit, St Mark’s Hospital;Hon. Senior Lecturer, Imperial College, 3ConsultantGastroenterologist & Co-Chair of the Lennard-JonesIntestinal Failure Unit, St Mark’s Hospital, 4SeniorLecturer/Honorary Consultant in Special Care Dentistry,5Consultant in Special Care Dentistry, Guys and StThomas’ NHS Foundation Trust, London, United Kingdom

Rationale: There are no published oral health studiesof people with long term intestinal failure requiring in-travenous nutrition (HPN). However, medical treatmentsused in this patient group can impact negatively on oralhealth and dental care delivery.Methods: 52 HPN outpatients were recruited from aspecialised nutrition clinic of a National referral centre.Consenting patients listed their medical and medicationhistory, perceived oral health and dental treatment in astructured interview and underwent an oral examination.Findings were compared with means from the 1998 UKAdult Dental Health Survey using one-sample t tests.Additionally, an e-mail questionnaire was sent to theUK HPN Group, to determine views on oral health andprescribing practices of consultant gastroenterologists(68% response rate).Results: The patient sample reflected the UK HPNpopulation (BANS 2008, BAPEN). Oral health of theHPN cohort was poorer than the UK norm; patientshad more decay (p < 0.001) fewer teeth (p < 0.001) andfewer sound and untreated teeth (p = 0.023) despitesimilar dental attendance. Hyperphagia, sip feeds, oralrehydration fluids and polypharmacy (in 96%), increasecaries, xerostomia (in 81%) and thus oral infection risk(including oral candidiasis). The patient pathway doesnot include oral health information. Management ofHPN related complications with bisphosphonate therapy,anticoagulation, and parenteral antibiotic prophylaxiswere associated with impaired access to dental care for33%. Patients were experiencing current problems (60%)and psychological discomfort (56%) from poor oral health,but were less anxious about dental treatment. Gastroen-terologists report concern that dental disease/treatmentcould impact on patient health.Conclusion: HPN patients have multiple risk factors thatadversely affect oral health, thus potentially diet andwell-being. Guidance on oral health and dental careprovision is required.

Disclosure of Interest: None declared