The Role of Fistuloclysis in the Treatment of Patients With Enteroatmospheric Fistulas

Abstract

Background: Enterocutaneous fistulas represent a connection between the gastrointestinal tract and adjacent tissues. Among them, there is a subdivision - the enteroatmospheric fistulas, in which the origin is the gastrointestinal tract in connection with the external environment through an open wound in the abdomen. Due to the high output in enterocutaneous fistulas, the loss of fluids, electrolytes, minerals and proteins leads to complications such as sepsis, malnutrition and electrolyte derangements. The parenteral nutrition has its secondary risks, and the fistuloclysis, that consist in the infusion of enteral feeding and also the chyme through the distal fistula, represents an alternative to the management of these patients until the definitive surgical approach. Aim: To evaluate the current evidence on the fistuloclysis technique, its applicability, advantages and disadvantages for patients with high output fistulas. Method: A systematic literature search was conducted in May 2020 with the headings “fistuloclysis”, “chyme reinfusion” and “succus entericus reinfusion”, in the PubMed, Medline and SciELO databases. Results: There were 29 articles selected for the development of this narrative synthesis, from 2003 to 2020, including reviews and case reports. Conclusion: Fistuloclysis is a safe method which optimizes the clinical, nutritional, and immunological conditions of patients with enteroatmospheric fistulas, increasing the chances of success of the reconstructive procedure. In cases where the definitive repair is not possible, chances of reducing or even stopping the use of nutrition through the parental route are increased, thus representing a promising modality for the management of most challenging cases.

Current fistula management

“…Historically, fistuloclysis can be a logistically complex undertaking and requires highly motivated caretakers and patients. However, the benefits include improving the nutritional status, preventing atrophy of the distal bowel, and liberating from parenteral nutrition [35 ▪▪ ]. There are several ways which this can be accomplished, but frequently the patient is encouraged to continue oral intake or enteral nutrition administration.…”

Use of oral diet and nutrition support in management of stricturing and fistulizing Crohn's disease

“…Traditionally, PN was the nutrition modality used for entero-atmospheric fistulas; however, fistuloclysis, in which a feeding tube is inserted into the distal limb of the fistula and nutrition is provided by the enteral route, has become a potential alternative. 49 This technique is relatively rare in the US population, however. 50 Entero-atmospheric fistulas secondary to CD are very rare, and there are no retrospective, prospective, or randomized controlled trials demonstrating efficacy for fistuloclysis in CD; however, there are few case reports and case series that describe this nutrition approach.…”

“…They are often secondary to a ventral hernia or prior surgery. Traditionally, PN was the nutrition modality used for entero‐atmospheric fistulas; however, fistuloclysis, in which a feeding tube is inserted into the distal limb of the fistula and nutrition is provided by the enteral route, has become a potential alternative 49 . This technique is relatively rare in the US population, however 50 .…”