Management of external gastrointestinal fistulas with glucose and lipids

Thirty-one patients with 35 external gastrointestinal fistulas were initially managed conservatively with total parenteral nutrition. Patients received the centrally infused glucose system or the peripherally infused lipid system, or both systems, in sequence. Eighteen of the fistulas closed spontaneously, and nine patients died. Eleven of the 15 fistulas managed exclusively with the lipid system closed spontaneously. The results of this retrospective study attest, in general, to the value of total parenteral nutrition and, in particular, to the value of the lipid system which appears equally effective, at least in a subset of patients with fistulas.