Nutritional Management of Patients With Enterocutaneous Fistulas: Practice and Progression

Area of Science:

• Gastroenterology
• Surgical Management
• Nutritional Science

Background:

• Enterocutaneous fistulas (ECF) present significant management challenges due to fluid and electrolyte loss, potentially leading to dehydration, malnutrition, and sepsis.
• Nutritional support is critical for managing ECF and promoting successful closure.

Purpose of the Study:

• To review the principles and methods of nutritional support in enterocutaneous fistula management.
• To discuss various enteral nutrition techniques and device-assisted occlusion methods for ECF.

Main Methods:

• Review of current literature on nutritional support strategies for ECF.
• Discussion of enteral nutrition delivery methods, including fistuloclysis and relay perfusion.
• Overview of device-based ECF occlusion techniques and their application.

Main Results:

• Enteral nutrition (EN) is the preferred nutritional support for ECF, supplemented by parenteral nutrition (TPN) if necessary.
• Early EN, if tolerated, protects the gut mucosal barrier and prevents bacterial translocation, crucial for healing.
• Various methods exist for EN delivery and ECF occlusion, but acute fistulas require caution due to tissue edema.

Conclusions:

• Prioritizing EN is fundamental in ECF management to mitigate complications and facilitate closure.
• While TPN may be indicated, early EN is advocated to preserve gut integrity.
• Specialized devices and techniques can aid ECF closure, but are contraindicated in acute phases.