Nutritional assessment and nutritional therapy for enterocutaneous and enteroatmospheric fistulas: A scoping review

Nutritional therapy can help balance effluent loss and fistula healing, and nutritional status is crucial for successful outcomes. The latest guidelines on the topic were published in 2016, and to answer the question "What are the nutritional strategies and tools used in the assessment and treatment of enterocutaneous and enteroatmospheric fistulas?", this scoping review included publications from 2016 onward, without age, sex, or language restrictions, identified through searches on PubMed, CENTRAL, BVS, and Embase databases. Search, study selection, eligibility analysis, and data extraction were performed independently by two authors, and a third reviewer resolved disagreements. Of the 5144 manuscripts found, 85 were eligible: 44 case reports, 39 cohort studies, and two clinical trials. Enterocutaneous fistulas were the most cited. At least one nutritional assessment method was reported by 59 of 85 manuscripts, mainly biochemical tests. Few authors evaluated nutritional risk and malnutrition. To determine nutritional requirements, two manuscripts used indirect calorimetry, and 16 considered kcal/kg and grams of protein/kg. It was not possible to stratify the feeding route regarding fistula location or output. Parenteral nutrition was most prevalent, followed by enteral nutrition, oral nutrition, chyme reinfusion, and fistuloclysis. It was not possible to establish dosage, frequency, or duration of treatment for specific nutrient supplementation (n = 10, 11.8%). Based on the findings of this review, it is suggested that future studies should assess the impact of body composition and nutritional status on clinical outcomes in these patients; validate appropriate methods and equations for determining basal energy expenditure; compare the use of oligomeric and polymeric formulas and evaluate the impact of early versus delayed nutritional therapy; explore criteria for choosing and transitioning the feeding route and; determine whether there is effectiveness in supplementation with specific nutrients. Additionally, it is important that studies provide a detailed description of the included population. The use of reporting guidelines is recommended. OSF registration: T92BQ.