Management of complications in patients with an ileostomy: an umbrella review of systematic reviews for the EndOTrial Consortium.

Neeraj Narula, Yuhong Yuan, Virginia Solitano, Sudheer Kumar Vuyyuru, Jurij Hanzel, Florian Rieder, Christopher Ma, Vipul Jairath, Siddharth Singh, Megan Hutton, Julie Ann Van Koughnett

Journal: International journal of colorectal disease 2024;39(1):147

PMID: 39304546

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Abstract

BACKGROUND

Standardized clinical care processes for patients with Crohn's disease (CD) and a permanent ileostomy (PI) are lacking. The EndOTrial consortium aims to address this gap by developing pathways for care.

METHODS

In this umbrella review, we searched major databases for relevant systematic reviews (SRs) or scoping reviews (ScR) published until January 5, 2024. Screening, data extraction, and quality appraisal (AMSTAR 2) were performed by two independent reviewers.

RESULTS

Of 1349 screened papers, 22 reviews met our inclusion criteria, including 20 SRs (eight with meta-analysis) and 2 ScRs. None exclusively focused on PI. Furthermore, nine reviews did not mention patients with inflammatory bowel disease (IBD), and only two reviews included patients with high-output ileostomy, highlighting a large evidence gap. The identified reviews covered six categories with nine types of interventions, including ostomy care pathways, peristomal skin care, patient education, clinical management of high-output stoma, management and prevention of postoperative ileus, dietary and nutritional support, nursing and supporting care, telemedicine, and self-management interventions. Most SRs including nursing interventions for stoma care highlighted nurses' role in a variety of standard and specialized treatments. Notably, none of the reviews exclusively examined disease recurrence, stoma pouching systems or adhesives, behavioral interventions, or mental health in patients living with ileostomy.

CONCLUSIONS

Evidence for best practice interventions to treat complications and improve quality of life in patients living with an ileostomy for CD is limited and heterogeneous. These results outline the need for standardized clinical care processes and pathways tailored to the unique needs of this patient population.

Address: Department of Medicine, Division of Gastroenterology, Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.; Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy.; Department of Medicine, Division of Gastroenterology, Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.; Alimentiv Inc, London, ON, Canada.; Department of Medicine, Division of Gastroenterology, Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.; Lawson Health Research Institute, London, ON, Canada.; Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.; Department of Medicine, Division of Gastroenterology, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada.; Alimentiv Inc, London, ON, Canada.; Division of Gastroenterology & Hepatology, University of Calgary, Calgary, AB, Canada.; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.; Alimentiv Inc, London, ON, Canada.; Department of Gastroenterology, University Medical Centre Ljubljana, University of Ljubljana, Ljubljana, Slovenia.; Nursing Practice Excellence and Innovation, London Health Sciences Centre, London, ON, Canada.; Division of General Surgery, Department of Surgery, University of Western Ontario, London, ON, Canada.; Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.; Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.; Program for Global Translational Inflammatory Bowel Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA.; Department of Medicine, Division of Gastroenterology, Department of Epidemiology and Biostatistics, Western University, London, ON, Canada. [email protected].; Alimentiv Inc, London, ON, Canada. [email protected].; Department of Epidemiology and Biostatistics, Western University, London, ON, Canada. [email protected].

DOI: 10.1007/s00384-024-04714-8