Medical Nutrition Therapy In Enterocutaneous Fistula: A Step-By-Step Approach

Main Article Content

Maggie Nathania
Diyah Eka Andayani

Abstract

Enterocutaneous fistula (ECF) management is a challenge that requires a multidisciplinary team approach in achieving optimal clinical output. Nutrition as a component of management plays a vital role in determining the prognosis, both as a predictor of morbidity and mortality. Malnutrition can also occurs as a preceeding situation or complication of ECF caused by the underlying disease, decreased food intake, increased protein requirements associated with systemic inflammation, and increased nutrient loss associated with the amount of fistula output. Thus, nutrition management can act as prevention, therapy, or both. Nutritional medical therapy in ECF cases aims to adequately estimate nutritional needs, maintain fluid and electrolyte balance, and stimulate spontaneous ECF closure whenever possible. To achieve optimal outcome, nutrition needs analysis must be done individually by considering the etiology, anatomical location of the fistula, and the amount of output. In the following article, we will discuss a comprehensive step-by-step nutrition treatment, both from the nutritional routes consideration, macronutrient and micronutrient requirements, specific nutrients, pharmacotherapy, and monitoring and evaluation that need to be done to achieve optimal clinical outcomes. 

Article Details

Section
Articles
Author Biographies

Maggie Nathania, Department of Nutrition, Faculty of Medicine, Universitas Indonesia

Clinical Nutrition Resident - Department of Nutrition, Faculty of Medicine, Universitas Indonesia

Diyah Eka Andayani, Faculty of Medicine, Universitas Indonesia

Department of Nutrition

References

Gribovskaja-Rupp I, Melton GB. Enterocutaneous fistula: proven strategies and updates. Clin Colon Rectal Surg. 2016;29:130–7.

Dumas RP, Moore SA, Sims CA. Enterocutaneous Fistula: evidence-based management. Clin Surg. 2017;2:1435.

Badrasawi MM, Shahar S, Sagap I. Nutritional management of enterocutaneous fistula: A retrospective study at a Malaysian university medical center. J Multidiscip Heal. 2014;7:365.

Davis KG, Johnson EK. Controversies in the Care of the Enterocutaneous Fistula [Internet]. Vol. 93, Surgical Clinics of North America. 2013. p. 231–50.

Williams LJ, Zolfaghari S, Boushey RP. Complications of enterocutaneous fistulas and their management. Clin Colon Rectal Surg. 2020;23:209–20.

Dodiyi-Manuel A, Wichendu PN. Current concepts in the management of enterocutaneous fistula. Int Surg J. 2018;5:1981–5.

Fazio VW, Coutsoftides T, Steiger E. Factors influencing the outcome of treatment of small bowel cutaneous fistula. World J Surg. 1983;7:481–8.

De Aguilar-Nascimento JE, Caporossi C, Borges Dock-Nascimento D, De Arruda IS, Moreno K, Moreno W. Oral glutamine in addition to parenteral nutrition improves mortality and the healing of high-output intestinal fistulas. Nutr Hosp. 2007;22:672–6.

Gallaher DD, Trudo SP. Chapter 36 - Nutrition and Colon Cancer A2 - Coulston, Ann M. In: Nutrition in the Prevention and Treatment of Disease. 2017. p. 787–807.

Lévy E, Frileux P, Cugnenc PH, Honiger J, Ollivier JM, Parc R. High-output external fistulae of the small bowel: Management with continuous enteral nutrition. Br J Surg. 1989;76:676–9.

Kumpf VJ, de Aguilar‐Nascimento JE, Diaz‐Pizarro Graf JI, Hall AM, McKeever L, Steiger E, et al. ASPEN‐FELANPE Clinical Guidelines: Nutrition Support of Adult Patients With Enterocutaneous Fistula. J Parenter Enter Nutr. 2017;41:104–12.

Polk TM, Schwab CW. Metabolic and nutritional support of the enterocutaneous fistula patient: A three-phase approach. World J Surg. 2012;36:524–33.

Datta V, Engledow. A, Chan S, Forbes A, Richard Cohen C, Windsor A. The management of enterocutaneous fistula in a regional unit in the United Kingdom: A prospective study. Dis Colon Rectum. 2010;53:192–9.

Coetzee E, Rahim Z, Boutall A, Goldberg P. Refeeding enteroclysis as an alternative to parenteral nutrition for enteric fistula. Color Dis. 2014;16:823–30.

Niu D-G, Yang F, Tian W-L, Zhao Y-Z, Li C, Ding L-A, et al. A technique to establish fistuloclysis for high-output jejunocutaneous fistula through percutaneous enterostomy. Medicine (Baltimore). 2019;98:e14653.

Shaffer J, Klek S, Dudrick’s Memorial Hospital S. Nutritional Support in Gastrointestinal Diseases Topic 12 Module 12.3 Nutrition and Gastrointestinal Fistulas Learning Objectives [Internet]. 2018.

Harriman S, Rodych N, Hayes P, Moser MAJ. The C-reactive protein-to-prealbumin ratio predicts fistula closure. Am J Surg. 2011;202:175–8.

Badrasawi M, Shahar S, Sagap I. Nutritional management in enterocutaneous fistula. What is the evidence? Malaysian J Med Sci. 2015;22:6–16.

Klek S, Forbes A, Gabe S, Holst M, Wanten G, Irtun Ø, et al. Management of acute intestinal failure: A position paper from the European Society for Clinical Nutrition and Metabolism (ESPEN) Special Interest Group. Clin Nutr. 2016;35:1209–18.

McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenter Enter Nutr. 2016;40:159–211.

Martinez JL, Bosco-Garate I, Souza-Gallardo LM, Méndez JD, Juárez-Oropeza MA, Román-Ramos R, et al. Effect of Preoperative Administration of Oral Arginine and Glutamine in Patients with Enterocutaneous Fistula Submitted to Definitive Surgery: a Prospective Randomized Trial. J Gastrointest Surg. 2020;24:426–34.

Langlois PL, D’Aragon F, Hardy G, Manzanares W. Omega-3 polyunsaturated fatty acids in critically ill patients with acute respiratory distress syndrome: A systematic review and meta-analysis. Vol. 61, Nutrition. Elsevier Inc.; 2019. p. 84–92.

Koekkoek W (Kristine), Panteleon V, van Zanten AR. Current evidence on ω-3 fatty acids in enteral nutrition in the critically ill: A systematic review and meta-analysis. Vol. 59, Nutrition. Elsevier Inc.; 2019. p. 56–68.

Dushianthan A, Cusack R, Burgess VA, Grocott MPW, Calder P. Immunonutrition for adults with ARDS: Results from a cochrane systematic review and meta-analysis. Respir Care. 2020;65:99–110.

Stevens P, Foulkes RE, Hartford-Beynon JS, Delicata RJ. Systematic review and meta-analysis of the role of somatostatin and its analogues in the treatment of enterocutaneous fistula. Vol. 23, European Journal of Gastroenterology and Hepatology. Eur J Gastroenterol Hepatol; 2011. p. 912–22.

Rahbour G, Siddiqui MR, Ullah MR, Gabe SM, Warusavitarne J, Vaizey CJ. A meta-analysis of outcomes following use of somatostatin and its analogues for the management of enterocutaneous fistulas. Ann Surg. 2012;256:946–54.

Coughlin S, Roth L, Lurati G, Faulhaber M. Somatostatin analogues for the treatment of enterocutaneous fistulas: A systematic review and meta-analysis. Vol. 36, World Journal of Surgery. World J Surg; 2012. p. 1016–29.

de Vries FEE, Reeskamp LF, van Ruler O, van Arum I, Kuin W, Dijksta G, et al. Systematic review: pharmacotherapy for high-output enterostomies or enteral fistulas. Vol. 46, Alimentary Pharmacology and Therapeutics. Blackwell Publishing Ltd; 2017. p. 266–73.

Visschers RGJ, Olde Damink SWM, Schreurs M, Winkens B, Soeters PB, van Gemert WG. Development of hypertriglyceridemia in patients with enterocutaneous fistulas. Clin Nutr. 2009;28:313–7.

Cheatham ML, Safcsak K, Brzezinski SJ, Lube MW. Nitrogen balance, protein loss, and the open abdomen*. Crit Care Med. 2007;35:127–31.

Cowan KB, Cassaro S. Fistula, Enterocutaneous [Internet]. Treasure Island (FL): StatPearls Publishing; 2020.

Quinn M, Falconer S, McKee RF. Management of Enterocutaneous Fistula: Outcomes in 276 Patients. World J Surg. 2017;41:2502–11.