Home Artificial Nutrition

List of Members  -  HPN Book  -  Works presented by HAN  -  Studies in progress  -  Survey on HAN -  Contact HAN

Status: ESPEN Special Interest Group

Field of interest: Home Artificial Nutrition (enteral and parenteral)

Aims: To perform scientific and epidemiological studies in the field of HAN.
To provide guidelines for HAN.
To participate in the education of professionals with an interest in HAN.

Composition of the group: The ESPEN-HAN Working Group has a maximum of 10 members.
The group is multidisciplinary and members are selected among pharmacists, nurses, dieticians and doctors.
Membership of the group is normally limited to 3-4 years.
If a member initiates a study he or she can stay in the group until the study is completed.

Presentation of the work of HAN: The coordinator of the study is normally the first author of the publication.
Those who contributed to the study are thanked in the "acknowledgements" section.
Papers are submitted to the ESPEN meetings and Clinical Nutrition or other relevant journals.

Meetings of the HAN group: The group convenes for two meetings every year. The Winter meeting is held during a week-end in January or February in a city of one of the members.

The second meeting takes place during the ESPEN meeting in August or September.

An open meeting is organized when appropriate during the ESPEN congress in order to give delegates the opportunity to learn about the activities of the group. The information on the web site is adjusted at half-year intervals or when appropriate.

Renewal of the group: Members of the group must be replaced continuously in order to assure the continuity of the group. Duration of the membership is 3-4 years.

Proposition of new members will be based on common sense in order to maintain the multinational and multidisciplinary composition of the group.

Members must fulfil the following criteria: Members of ESPEN
Enthusiastic to participate in the work of the group.
Expertise in the field of HAN.
Members must be approved by their national society for clinical nutrition
A list of the members of the HAN group will be submitted to ESPEN Central each year.

Financial support: ESPEN provides financial support. The budget has to be accepted by ESPEN Central. All expenses must be clearly defined (meetings, secretariat, mailing etc.).

Members of HAN group are encouraged to generate financial support from pharmaceuticals companies or other societies. The ESPEN treasurer will control any money raised.

Home Parenteral Nutrition Book (New in 2006!)

Containing contributions from leading international experts and under the auspices of the ESPEN HAN Group, this book explores the life-saving treatment of home parenteral nutrition. It covers the complete scenario of home parenteral nutrition (HPN), from its prevalence in different continents to clinical indications and the practical aspects of its management. Topics covered inlcude the growing use of HPN, scientific and practical issues associated with HPN in adults and the pediatric population, indications and outcomes in various diseases, complications, nutrient requirements, preparation and administration of the admixtures, monitoring of patients, medical and surgical alternatives, ethics and legislation, and quality of life. To order it, click here.

Works presented by HAN 

  1. Monitoring of patients on home parenteral nutrition (HPN) in Europe: A questionnaire based study on monitoring practice in 42 centres. Wengler A, Micklewright A, Hébuterne X, Bozzetti F, Pertkiewicz M, Moreno J, Pironi L, Thul P, Van Gossum A, Staun M; ESPEN-Home Artificial Nutrition working group. Clin Nutr 2006;25:693-700
  1. Candidates for intestinal transplantation: a multicenter survey in Europe. Pironi L, Hébuterne X, Van Gossum A, Messing B, Lyszkowska M, Colomb V, Forbes A, Micklewright A, Villares JM, Thul P, Bozzetti F, Goulet O, Staun M. Am J Gastroenterol 2006;101:1633-43
  1. Bone mineral density in patients on home parenteral nutrition: a follow-up study. Pironi L, Tjellesen L, De Francesco A, Pertkiewicz M, Morselli Labate AM, Staun M, Przedlacki J, Lezo A, Orlandoni P, Pasanisi F; ESPEN-home artificial nutrition working group. Clin Nutr 2004;23:1288-302
  1. Home enteral nutrition in adults: a European multicentre survey. Hébuterne X, Bozzetti F, Moreno Villares JM, Pertkiewicz M, Shaffer J, Staun M, Thul P, Van Gossum A; ESPEN-Home Artificial Nutrition Working Group. Clin Nutr 2003;22:261-6
  1. Central venous catheter complications in 447 patients on home parenteral nutrition: an analysis of over 100.000 catheter days. Bozzetti F, Mariani L, Bertinet DB, Chiavenna G, Crose N, De Cicco M, Giglig, Micklewright A, Moreno Villares JM, Orban A, Pertkiewicz M, Pironi L, Vilas MP, Prins F, Thul P. Clin Nutr 2002;21:475-85
  1. Prevalence of bone disease in patients on home parenteral nutrition. Pironi L, Labate AM, Pertkiewicz M, Przedlacki J, Tjellesen L, Staun M, De Francesco A, Gallenca P, Guglielmi FW, Van Gossum A, Orlandoni P, Contaldo F, Villares JM; Espen-Home Artificial Nutrition Working Group. Clin Nutr 2002;21:289-96
  1. Clinical, social and rehabilitation status of long-term home parenteral nutrition patients: results of a European multicentre survey. Van Gossum A, Vahedi K, Abdel-Malik, Staun M, Pertkiewicz M, Shaffer J,Hébuterne X, Beau P, Guédon C, Schmit A, Tjellesen L, Messing B, Forbes A. Clin Nutr 2001;20:205-10
  1. Survey on legislation and funding of Home Artificial Nutrition in different european countries. Moreno JM, Shaffer J, Staun M, Hébuterne X, Bozzetti F, Pertkiewicz M, Thul P, Van Gossum A. Clin Nutr 2001;20:117-23
  1. Home parenteral nutrition in adults: A european multicentre survey in 1997. ESPEN-Home Artificial Nutrition Working Group. Van Gossum A, Bakker H, Bozzetti F, Staun M, Leon-Sanz M, Hébuterne X, Pertkiewicz M, Shaffer J, Thul P. Clin Nutr 1999;18:135-40
  1. Home Parenteral Nutrition (HPN) in children. A multicentre survey in Europe in 1997. Van Gossum A. et al. Clin Nutr 1998;17(suppl. 1):49
  1. A European survey on management of metabolic complications in home parenteral nutrition. Shaffer J. et al. Clin Nutr 1997; 16 (suppl. 2):73
  1. Home parenteral nutrition in adults: A multicentre survey in Europe in 1993. Van-Gossum A, Bakker H, De-Francesco A, Ladefoged K, Leon-Sanz M, Messing B, Pironi L, Pertkiewicz M, Shaffer J, Thul P, Wood S. Nutr Clin Métabol 1997;11:27-36

Studies in progress 

  1. Monitoring patients on home parenteral nutrition. Ann Micklewright & Anne Wengler
  2. A survey on management of intestinal failure in Europe. Michael Staun
  3. Indication for intestinal transplantation, a European survey. Loris Pironi
  4. A survey on HPN in adults in selected European centres. Michael Staun
  5. A survey on HPN in children in European centres. Malgorzata Lyszkowska
  • A multicentre prospective observational study on predictability of survival of advanced cancer patients on home parenteral nutrition. Federico Bozzetti

    Download information and case report form. (Word documents)


  • On behalf of the ESPEN Home Artificial Working group we kindly inform you about a prospective observational study on home parenteral nutrition (HPN) in patients with cancer. Centres from across Europe and possibly some overseas centres are invited to participate.

    It is well-known that nutritional support (enteral or parenteral) may be useful to malnourished or hypophagic patients with a poor tolerance to
    aggressive oncologic treatment, but only a limited percentage of advanced (incurable) cancer patients, who receive HPN as a unique treatment, will benefit with respect to the duration of survival.

    None the less, in many European series (single institutions or national registers) incurable malignancy is the most frequently reported indication for HPN. The advantages of this treatment are not obvious for the patient, and it is important to identify the patients with incurable cancer that will benefit the most from treat-ment with HPN.

    The main purpose of this prospective observational study is to be able to predict more accurately, on the basis of simple data at the beginning of HPN, the survival of patients with an active cancer, in order to more precisely formulate the recommendations for such treatment and possibly to restrict the indications for HPN to the population that presumably will benefit.

    The study is not demanding regarding resources, since only rather simple data are required in order to be able to fulfil the purpose of the study.
    For details kindly get in touch with the principal investigator.

    The study will start by June 2007. Please observe that in some centres/countries the approval of ethical committee may be required.

    The data will be presented at the ESPEN conference and other international and national meetings and as a full publication. Your contribution will be fully acknowledged.

    Kind regards

    Federico BOZZETTI, Principal investigator

    Michael STAUN, Chairman/secretary HANW

Survey on HAN

An European Survey on Adult Home Parenteral Nutrition in 1997.
A. VAN GOSSUM et al.

ABSTRACT

A retrospective survey on home parenteral nutrition (HPN) in Europe was performed covering the period of January to December 1997. Data were compared to a similar study performed in 1993.

A questionnaire of HPN practice was designed by the members of the ESPEN-HAN group. This involved adult patients (more than 16 y.) newly registered in an HPN program between January 1st and December 31st 1997, and included: number of patients, underlying diseases and a 6-12 months outcome. Incidence and prevalence (at 1.1.1998) of adult HPN were calculated according to the estimated total population in 1997 for the countries in which more than 80% of HPN patients were reported.

A total of 494 patients were registered in 73 centres from 9 countries (Belgium (B), Denmark (D), France (F), Poland (P), Spain (S), Sweden (Sw.), United Kingdom (U.K), The Netherlands (N) and Germany (G). The underlying diseases for HPN in 494 patients were cancer (39%), Crohn’s (19%), vascular diseases (15%), radiation enteritis (7%), AIDS (2%), other diseases with intestinal failure (18%). Incidence (patients/million inhabitants/year) were in N (3), F. (2.9), D. (2.8), B. (2.6), U.K. (1.2), S. (0.7) and P. (0.36), respectively. Prevalence were in D. (12.7), U.K. (3.7), N. (3.7), F. (3.6), B. (3.0), P. (1.1), S. (0.65). After this 6-12 months follow-up (n=284), the mortality was respectively 4% in Crohn's disease, 13% in vascular diseases, 16% in others, 21% in radiation enteritis, 34% in AIDS, 74% in cancer.

Incidences and prevalences moderately increased in these 7 European countries in 1997 in comparison to 1993. The percentages of underlying diseases in these countries remained similar except for AIDS that significantly decreased (from 7% to 2%). Outcomes did not significantly differ in the 4 year period except for AIDS (34% instead of 88% mortality) and could have been related to newer, more efficacious therapy.

APPENDIX

We are indebted to contributors to HPN survey in Europe.

Belgium:
J. Bruyns; Payen; Body (Brussels)
A. Van Gossum; Y. Carpentier (Brussels)
P. Pattyn (Gent)
L. Filez (Leuven)
D. Ysebaert (Antwerp)

Denmark:
M. Staun (Copenhagen)
H. Rasmussen (Alborg)
O. Schaffalitzky de Muchadell (Odense)
K. Ladefoged (Koege)

France:
J.L. Bornet (Toulouse)
M. Gerard Boncompain (Lyon 1)
C. Chambrier (Lyon 2)
D. Barnoud (Grenoble)
C. Guedon (Rouen)
P. Beau (Poitiers)
J.M. Reimund (Strasbourg)
X. Hébuterne; S. Schneider (Nice)
M. Amouretti; Kerjean (Bordeaux)
J. Di Constanzo (Marseille)
B. Saint-Aubert; P. Senesse (Montpellier)
J.F. Bretagne (Rennes)
B. Messing; K. Vahedi (Paris)

Germany:
Ahrens (Freiburg)
Bär (Oldenburg)
Hermann (Marburg)
Jockam (Ravensburg)
Katz (Darmstadt)
Keller (Bonn)
Klare (Berlin)
Kruis (Köln)
Pasold (Postdam)
Passen (Rüdersdof)
Pölche (Celle)
Reiss (Hanover)
Scheurlen (Bonn)
Stern (Heidelberg)
Thul (Berlin)

Poland:
M. Pertkiewicz, K. Majewska (Warsaw)

Spain:
P.G. Peris; C. de la Cuerda (Madrid)
M. Leon-Sanz; J.M. Moreno (Madrid)
P.P. Garcia-Luna (Sevilla)
J. Ordonez (Santander)
C.G. Candela; A. de Cos (Madrid)
M. Planas (Barcelona)
J. Chamorro (Jaen)
A. Perez de la Cruz (Granada)
A.M. Pita (Barcelona)

Sweden:
S. Nordgren, J. Bosaens (Göteborg)
T. Hallgren (Karlstad)
B. Ojerskog (Uddevala)
K. Lundholm (Göteborg)

The Netherlands:
A. Bogers; E. Posma (Caremark N.V.; Utrecht)
D. Block; A. Wipkink (Leiden)
S. Timmermans; J.H. Bakker (Nymegen)
E. Oremus (Groningen)
F. Prins; C. Jonkers (Amsterdam)

United Kingdom:
J.L. Shaffer; A. Bradley (Salford)
A. Davidson, J. Hart (London)
S. Cottee (Cambridge)
C. Pennington, J. Tait (Dundee)
B. Jones (Dudley)
J. Field (Nottingham)
A. Jukes (Cardiff)
S. Hobday (Weston-Super-Mare)
S. Alston (Torquay)
G. Day (Derby)
F. Mac Leod (Southampton)
A. Brake (Southend)
G. Snape (Telford)
J. Mc Mahon (Inverness)
G. Mawhinney (Basildon)
E. Moore (Belfast)
D. Horsman (Leeds)