Fistuloclysis can successfully replace parenteral feeding in acute intestinal failure

Teubner, Antje; Farrer, K.; Ravishankar, Hariharan; Shaffer, Jon; Carlson, Gordon L

doi:10.1016/s0261-5614(03)80292-3

Cited by 4 publications

(8 citation statements)

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“…• Consideration of the possibility of distal feeding should be made. The distal bowel should be brought to the surface whenever possible [38,39] (Level of Evidence 4).…”

Section: Prevention Of Intestinal Failurementioning

confidence: 99%

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European Society of Coloproctology consensus on the surgical management of intestinal failure in adults

et al. 2016

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Intestinal failure (IF) is a debilitating condition of inadequate nutrition due to an anatomical and/or physiological deficit of the intestine. Surgical management of patients with acute and chronic IF requires expertise to deal with technical challenges and make correct decisions. Dedicated IF units have expertise in patient selection, operative risk assessment and multidisciplinary support such as nutritional input and interventional radiology, which dramatically improve the morbidity and mortality of this complex condition and can beneficially affect the continuing dependence on parenteral nutritional support. Currently there is little guidance to bridge the gap between general surgeons and specialist IF surgeons. Fifteen European experts took part in a consensus process to develop guidance to support surgeons in the management of patients with IF. Based on a systematic literature review, statements were prepared for a modified Delphi process. The evidence for each statement was graded using Oxford Centre for Evidence-Based Medicine Levels of Evidence. The current paper contains the statements reflecting the position and practice of leading European experts in IF encompassing the general definition of IF surgery and organization of an IF unit, strategies to prevent IF, management of acute IF, management of wound, fistula and stoma, rehabilitation, intestinal and abdominal reconstruction, criteria for referral to a specialist unit and intestinal transplantation.

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“…• Consideration of the possibility of distal feeding should be made. The distal bowel should be brought to the surface whenever possible [38,39] (Level of Evidence 4).…”

Section: Prevention Of Intestinal Failurementioning

confidence: 99%

“…• If a patient has an adequate length of healthy gut but is unable to consume and absorb adequate calories, enteral tube feeding (including fistuloclysis [39]) may be required (Level of Evidence 4).…”

Section: Management Of Acute Intestinal Failurementioning

confidence: 99%

European Society of Coloproctology consensus on the surgical management of intestinal failure in adults

et al. 2016

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“…With this method, weight and nutrition markers improved significantly. 11,31 Even so, as demonstrated by our case, as well as the study by Teubner et al, 16 the mixture of chyme to tube feedings is not necessary for adequate nutrition and may additionally present hygienic and esthetic issues. Although our patient had not experienced any complications while receiving EN, some reported complications of fistuloclysis may include abdominal pain, diarrhea, or increased proximal fistula output.…”

Section: October 2007 555mentioning

confidence: 49%

“…A rare complication encountered by others was a "swallowed" feeding tube, which had not been properly fixed and was internalized by peristaltic activity of the distal intestine. 32 Our patient's enterocutaneous fistula was repaired 113 days after fistuloclysis, whereas Teubner et al 16 report fistula takedown a median of 155 days after commencement of fistuloclysis in 9 of 11 patients. This may be due to octreotide therapy, which improves management of enterocutaneous fistulae by reducing pancreaticobiliary secretion volume.…”

Section: October 2007 555mentioning

confidence: 70%

“…[12][13][14][15] Fistuloclysis is a relatively novel procedure in which EN is provided via an enteral feeding tube placed directly into a high-output intestinal fistula. In a case series, Teubner et al 16 found that fistuloclysis replaced PN in 11 out of 12 patients, increased weight and serum albumin levels, and decreased the length of hospital stay. In a case report, a Foley catheter was placed through the fistula of a clinically deteriorating patient in order to provide EN, decreasing fistula output and speeding closure.…”

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confidence: 99%

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Fistuloclysis: Case Report and Literature Review

2007

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Enterocutaneous fistulae are a common postoperative entity, causing serious complications such as sepsis, malnutrition, and electrolyte and fluid abnormalities. Because sepsis coupled with malnutrition is the leading cause of death in these patients, it is especially important to provide nutrition support. Although parenteral nutrition (PN) is widely used in these patients, it is not without risks, because PN is known to cause liver dysfunction, among other problems. We report a case in which a male patient with an enterocutaneous fistula, having experienced increased liver enzymes receiving PN, began receiving enteral nutrition (EN) via a feeding tube placed in the fistula. Known as fistuloclysis, this method provided adequate nutrition and improved his serum albumin and prealbumin levels, body weight, and liver function tests. Upon stabilization of his nutrition status, he was able to undergo successful surgical repair of the enterocutaneous fistula. According to our experience and that of others, we recommend that patients with high-output enterocutaneous fistulae be considered for EN via fistuloclysis after nutrition stabilization with PN; then the fistulae can be surgically repaired if not spontaneously healed. Use of EN via fistuloclysis, if used appropriately, avoids the complications of long-term PN and may promote faster fistula healing.

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