Patient case: 62-year-old female with mucosal melanoma; genetic feature: KIT (L576P), KIT amplification

Clinical trial: Preoperative Oral ImmunoNuTrition to Improve Surgical Outcomes for IBD Patients (PINT)

Summary: The central focus of this trial is to understand the effectiveness of Preoperative Immunonutrition (PINT) in improving surgical outcomes for patients with inflammatory bowel disease (IBD). We hypothesize that PINT will reduce post-operative complications in IBD patients undergoing elective surgery with added improvements in length-of-stay (LOS), quality of life (QOL) and patient satisfaction. As a secondary focus, the investigator will aim to better understand the potential mechanism-of-action by which PINT may have its effects through analyses of biomarkers including inflammatory markers, nutritional proteins and the fecal microbiome.

Detailed description: Inflammatory bowel disease (IBD), which includes Crohn's and Ulcerative Colitis, is a chronic and costly disease of unknown etiology that now affects over 3.1 million people in the United States. Patients with IBD suffer from lifelong malnutrition, pain and bleeding with added risks of cancers, obstructions and fistulas. There is no known cure and the incidence continues to grow. While treatments are usually medical IBD patients will undergo at least one major surgery during their lifetime. Patients also have particularly poor surgical outcomes with high rates of post-operative complications. In an attempt to improve the risk profile of patients and decrease complications, preoperative total parenteral nutrition (TPN) has been used to optimize IBD patients for surgery. While this approach has been successful the cost and morbidities of TPN prohibit its generalized application. Practical strategies that improve surgical outcomes for IBD patients are urgently needed. Improving nutritional deficiencies before an operation may be a practical way to improve post-operative outcomes. The oral administration of preoperative immunonutrition, is an alternative method to improve nutritional states and may have utility in IBD patients who have particularly severe nutritional deficiencies because of disease-specific issues in malabsorption, maldigestion and loss of appetite.

Eligibility: Inclusion Criteria:
  -  ≥19 years of age
  -  All races and all genders
  -  Confirmed diagnosis and history of IBD
  -  ESPEN Nutritional Risk Scores >=3 and the ESPEN Disease Severity sub-score < 3
  -  Scheduled for elective surgery via any transabdominal operative approach (i.e. laparoscopic, hand-assisted, robotic, open) with a planned postoperative inpatient stay of at least one night
  Exclusion Criteria:
  -  Failure to meet eligibility criteria
  -  Patients requiring emergency surgical intervention
  -  Patients with an American Society of Anesthesiologist physical status of IV or V
  -  Patients requiring hemodialysis
  -  Patients with history of myocardial infarction within 6 months
  -  Patients with a history of asthma
  -  Patients with cirrhosis or a history of liver disease
  -  Patients with a present history of dysphagia, pyloric stenosis and esophageal strictures
  -  Patients unable to consume liquids orally
  -  Patients allergic or with hypersensitivity reactions to any of the components of the Nestlé IMPACT-Advanced Recovery immunonutritional supplement
  -  Patients with a history of galactosemia, the inability to metabolize the sugar galactose appropriately
  -  Patients with bowel obstructions
  -  Patients with history of HIV or of solid-organ transplant
  -  Patients who are pregnant or breastfeeding

Relevance to patient case: not relevant