Nutritional Management of Patients With Enterocutaneous Fistulas: Practice and Progression.

Qin-Qing Tang,Jian-An Ren,Tao Zheng,Jie-Shou Li,Guo-Sheng Gu,Hua-Jian Ren,Ge-Fei Wang,Zhi-Wu Hong,Lei Wu,Xiu-Wen Wu,Jun Chen

doi:10.3389/fnut.2020.564379

Abstract

The management of enterocutaneous fistulas (ECF) can be challenging because of massive fluid loss, which can lead to electrolyte imbalance, severe dehydration, malnutrition and sepsis. Nutritional support plays a key role in the management and successful closure of ECF. The principle of nutritional support for patients with ECF should be giving enteral nutrition (EN) priority, supplemented by parenteral nutrition if necessary. Although total parenteral nutrition (TPN) may be indicated, use of enteral feeding should be advocated as early as possible if patients are tolerant to it, which can protect gut mucosal barrier and prevent bacterial translocation. A variety of methods of enteral nutrition have been developed such as fistuloclysis and relay perfusion. ECF can also be occluded by special devices and then EN can be implemented, including fibrin glue application, Over-The-Scope Clip placement and three-dimensional (3D)-printed patient-personalized fistula stent implantation. However, those above should not be conducted in acute fistulas, because tissues are edematous and perforation could easily occur.

Highlights

An enterocutaneous fistula (ECF) is an abnormal connection between the gastrointestinal tract and the skin or atmosphere [1]
The results showed that patients in the low TFA group had a higher use of parenteral nutrition
The following patients should be considered for definitive surgery: [1] eversion of the mucosa of the fistula; [2] the fistula has not closed spontaneous within 30 days; [3] those conditions exist such as distal obstruction, inflammatory bowel disease, neoplasm, radiation enteritis

Summary

INTRODUCTION

An enterocutaneous fistula (ECF) is an abnormal connection between the gastrointestinal tract and the skin or atmosphere (enteroatmospheric fistula [EAF]) [1]. Low-output fistula has a higher likelihood of spontaneous closure, and a portion of patients with ECF will heal spontaneously with appropriate nutritional support and wound care [15]. Optimal nutritional support is closely related to the mortality rate and spontaneous fistula closure Klucinski et al [68] study showed that multiple fistulas, higher Creactive protein level, and longer time interval from admission to definitive surgery were associated with an increased risk of severe complications or fistula recurrence. Only multiple fistulas were an independent risk factor for severe complications or fistula recurrence in multivariate analysis Those patients with high output, EAF, and/or history of open abdomen have the highest risk of recurrence after definitive surgery. Pre-operative and postoperative use of TPN did not influence recurrence rate by univariate or multivariate analysis [71]

CONCLUSIONS

Findings

ETHICS STATEMENT