Nutrition Support of Adult Patients With Enterocutaneous Fistula
Publication Date: December 2, 2016
Last Updated: March 14, 2022
Recommendations
We suggest the following:
- Malnutrition be diagnosed by nutrition history, including unintentional weight loss and estimation of energy/nutrient intake, and physical examination.
- Assessment for malnutrition be conducted at the time of diagnosis of an ECF. If malnutrition is not present at baseline, periodic nutrition assessment is warranted as patients with fistulas have a high likelihood of becoming malnourished due to nutrient malabsorption, fluid and electrolyte losses, and sepsis.
- Serum protein concentrations be obtained prior to and during nutrition therapy since they are prognostic outcome indicators, yet are not sensitive nutrition markers.
658
After stabilization of fluid and electrolyte balance, we suggest that oral diet or EN may be feasible and tolerated in patients with low-output (<500 mL/d) ECF (suggesting no distal obstruction). However, patients with high-output ECF (>500 mL/d) may require PN to meet fluid, electrolyte, and nutrient requirements to support spontaneous or surgical closure of the ECF. (, VL - Very Low)
658
Based on expert consensus, we suggest the provision of protein at 1.5–2.0 g/kg/d and energy intake appropriate to the patient’s energy requirements based on results of nutrition assessment. More protein may be required (up to 2.5 g/kg/d) in patients with enteroatmospheric fistula and high fistula output. (, )
(Based on consensus only, as no recent evidence was available.)
658
- We suggest the use of fistuloclysis for nutrition therapy for patients with intact intestinal absorptive capability distal to the infusion site and when the infusion ECF site is not expected to close spontaneously.
- We suggest the use of polymeric formulas initially and change to semi-elemental (oligomeric) diet if intolerance occurs.
658
We cannot recommend multicomponent immune-enhancing formulas to improve outcomes of ECF due to lack of evidence. We suggest that oral glutamine in addition to PN may improve mortality and fistula closure rates. (, VL - Very Low)
658
We recommend use of somatostatin analogue in adult patients with high-output (>500 mL/d) ECF as a method to reduce effluent drainage and enhance spontaneous closure. (, M - Moderate)
658
Based on expert consensus, we suggest consideration of HPN when the patient is medically stable and the fistula output is manageable, as well as in patients with high-output ECF (>500 mL/d) when surgical repair is not yet advised. (, )
(Based on consensus only, as no recent evidence was available.)
658
Recommendation Grading
Overview
Title
Nutrition Support of Adult Patients With Enterocutaneous Fistula
Authoring Organization
American Society for Parenteral and Enteral Nutrition
Publication Month/Year
December 2, 2016
Last Updated Month/Year
January 16, 2024
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adult
Health Care Settings
Emergency care, Hospital, Long term care
Intended Users
Medical assistant, dietician nutritionist, nurse, nurse practitioner, physician, physician assistant
Scope
Management
Diseases/Conditions (MeSH)
D018529 - Nutritional Support, D017577 - Cutaneous Fistula
Keywords
Nutrition Support , Enterocutaneous Fistula, inflamed bowel
Supplemental Methodology Resources
Methodology
Number of Source Documents
153
Literature Search Start Date
January 1, 1995
Literature Search End Date
June 1, 2016