Evaluation of the Effectiveness of In-line Immobilized Lipase Cartridge in Enterally Fed Patients With SHORT BOWEL SYNDROME: A RETROSPECTIVE CASE SERIES
Presenter Status
Resident/Psychology Intern
Abstract Type
Clinical Research
Primary Mentor or Principal Investigator
William O. San Pablo
Presentation Type
Poster
Start Date
19-5-2026 12:00 PM
End Date
19-5-2026 1:00 PM
Abstract Text
Patients with short bowel syndrome (SBS) experience nutrient malabsorption. The clinical manifestations of malabsorption are heterogeneous due to the variety of congenital and acquired anatomic abnormalities that result in SBS. Because of various gastrointestinal pathophysiologic alterations, fat malabsorption is an important nutritional factor to consider. The Intestinal Rehabilitation Program at Children’s Mercy has been providing a comprehensive approach to caring for children with SBS, and has incorporated RELiZORB (Alcresta Therapeutics, Inc.) immobilized lipase cartridge (ILC) into their treatment armamentarium. ILC is a single-use digestive enzyme cartridge that connects in-line with enteral feeding circuits to hydrolyze triglycerides in enteral formulas. Although ILC use has been associated with improved fat absorption and enteral feeding tolerance in patients with exocrine pancreatic insufficiency (EPI) and cystic fibrosis, there are no published reports of ILC use in patients with SBS.
Objectives and Methods
The primary objective of this retrospective single-center case series was to evaluate the effectiveness of ILC in children with SBS. Patients whose care was managed by the Intestinal Rehabilitation team at Children’s Mercy Kansas City from 2015 to August 2024 were included in the study if they were diagnosed with SBS, between the ages of 2 and 21 years at the initiation of ILC use and had used ILC for a minimum of 3 months. Two patients were excluded from the analysis: one patient was prescribed ILC for EPI associated with acute pancreatitis, one patient had poor compliance (< 60%) with ILC use.
Results
Growth, enteral nutrition (EN) by tube feeding, and parenteral nutrition (PN) measurements for fourteen children were included in the analysis; ten were PN and EN dependent and 4 were EN dependent. Etiologies of SBS included necrotizing enterocolitis (n=3), volvulus (n=3), gastroschisis (n=2), atresia (n=2), gastroschisis and atresia (n=2), and trauma (n=2). The majority of patients had Type III SBS, and a mean age of 6 years (range 2 to 15 years) when ILC was started. Mean ILC use was 2 (range 1 to 3) per day; up to 500 mL EN per device. The estimated mean residual small bowel length in 13 patients was 66 ± 51 cm (range 11 to 190 cm). Fifty percent of the patients retained their ileocecal valve and 50 % had colonic resection. Of the 10 patients with baseline fecal elastase testing, 70% had normal values (>200 µg/g). None of the patients were receiving teduglutide during the analysis period.
Figure 1: A) The percent change in PN use, B) Percent change in EN use, and C) Change in weight Z-score over the first 3 months of ILC use is shown for the PN-Dependent population.
Within the first 3 months of ILC use:
↓ in PN use (kcal/kg/day) in 7 of 10 patients
↑ in EN use (kcal/kg/day) in 5 of 10 patients
↑ weight Z-score in 6 of 10 patients
These results suggest an increased tolerability to tube feeding with ILC use resulting in an initial trend towards decreasing PN dependence.
In the four patients dependent on EN (no PN), within the first 2 months of ILC use:
↑ weight Z-score in 3 of 4 patients with a mean improvement in Z-score of 0.40
Minimal mean change (< 5%) in EN use (kcal/kg/day)
These results suggest an increased nutrient absorption with ILC use.
Conclusions
-
In this single-center case series, ILC use in pediatric patients with SBS receiving enteral nutrition demonstrated promising outcomes.
-
In patients requiring PN, improved EN tolerability and a reduction in PN dependence was observed in the first 3 months of ILC use.
-
In patients with enteral autonomy and SBS, an improvement in weight z-score was observed within 2 months of ILC use.
-
These findings suggest that fat malabsorption plays a role in EN tolerance in pediatric patients with SBS.
Evaluation of the Effectiveness of In-line Immobilized Lipase Cartridge in Enterally Fed Patients With SHORT BOWEL SYNDROME: A RETROSPECTIVE CASE SERIES
Patients with short bowel syndrome (SBS) experience nutrient malabsorption. The clinical manifestations of malabsorption are heterogeneous due to the variety of congenital and acquired anatomic abnormalities that result in SBS. Because of various gastrointestinal pathophysiologic alterations, fat malabsorption is an important nutritional factor to consider. The Intestinal Rehabilitation Program at Children’s Mercy has been providing a comprehensive approach to caring for children with SBS, and has incorporated RELiZORB (Alcresta Therapeutics, Inc.) immobilized lipase cartridge (ILC) into their treatment armamentarium. ILC is a single-use digestive enzyme cartridge that connects in-line with enteral feeding circuits to hydrolyze triglycerides in enteral formulas. Although ILC use has been associated with improved fat absorption and enteral feeding tolerance in patients with exocrine pancreatic insufficiency (EPI) and cystic fibrosis, there are no published reports of ILC use in patients with SBS.
Objectives and Methods
The primary objective of this retrospective single-center case series was to evaluate the effectiveness of ILC in children with SBS. Patients whose care was managed by the Intestinal Rehabilitation team at Children’s Mercy Kansas City from 2015 to August 2024 were included in the study if they were diagnosed with SBS, between the ages of 2 and 21 years at the initiation of ILC use and had used ILC for a minimum of 3 months. Two patients were excluded from the analysis: one patient was prescribed ILC for EPI associated with acute pancreatitis, one patient had poor compliance (< 60%) with ILC use.
Results
Growth, enteral nutrition (EN) by tube feeding, and parenteral nutrition (PN) measurements for fourteen children were included in the analysis; ten were PN and EN dependent and 4 were EN dependent. Etiologies of SBS included necrotizing enterocolitis (n=3), volvulus (n=3), gastroschisis (n=2), atresia (n=2), gastroschisis and atresia (n=2), and trauma (n=2). The majority of patients had Type III SBS, and a mean age of 6 years (range 2 to 15 years) when ILC was started. Mean ILC use was 2 (range 1 to 3) per day; up to 500 mL EN per device. The estimated mean residual small bowel length in 13 patients was 66 ± 51 cm (range 11 to 190 cm). Fifty percent of the patients retained their ileocecal valve and 50 % had colonic resection. Of the 10 patients with baseline fecal elastase testing, 70% had normal values (>200 µg/g). None of the patients were receiving teduglutide during the analysis period.
Figure 1: A) The percent change in PN use, B) Percent change in EN use, and C) Change in weight Z-score over the first 3 months of ILC use is shown for the PN-Dependent population.
Within the first 3 months of ILC use:
↓ in PN use (kcal/kg/day) in 7 of 10 patients
↑ in EN use (kcal/kg/day) in 5 of 10 patients
↑ weight Z-score in 6 of 10 patients
These results suggest an increased tolerability to tube feeding with ILC use resulting in an initial trend towards decreasing PN dependence.
In the four patients dependent on EN (no PN), within the first 2 months of ILC use:
↑ weight Z-score in 3 of 4 patients with a mean improvement in Z-score of 0.40
Minimal mean change (< 5%) in EN use (kcal/kg/day)
These results suggest an increased nutrient absorption with ILC use.
Conclusions
-
In this single-center case series, ILC use in pediatric patients with SBS receiving enteral nutrition demonstrated promising outcomes.
-
In patients requiring PN, improved EN tolerability and a reduction in PN dependence was observed in the first 3 months of ILC use.
-
In patients with enteral autonomy and SBS, an improvement in weight z-score was observed within 2 months of ILC use.
-
These findings suggest that fat malabsorption plays a role in EN tolerance in pediatric patients with SBS.
Comments
Full text not provided by primary author
Poster Board Number: 16