Fistuloclysis Improves Liver Function and Nutritional Status in Patients with High-Output Upper Enteric Fistula

Abstract

Background. We aimed to determine the efficacy of fistuloclysis in patients with high-output upper enteric fistula (EF). Methods. Patients were assigned into the fistuloclysis group (n = 35, receiving fistuloclysis plus total enteral nutrition (TEN)) and the control group (n = 60, receiving TEN). Laboratory variables were measured during the four-week treatment. Results. At baseline, variables were similar between the two groups. Delta value was defined as the changes from baseline to day 28. Compared with the control group, the fistuloclysis group showed greater improvements in liver function (Delta total bilirubin (TB): 20.3 ± 9.7 in the fistuloclysis group versus 15.6 ± 6.3 in the control group, P = 0.040; Delta direct bilirubin (DB): 12.5 ± 3.4 versus 10.0 ± 3.6, P = 0.011; Delta alkaline phosphatase (ALP): 98.4 ± 33.5 versus 57.6 ± 20.9, P < 0.001); nutritional status (Delta total protein: 21.8 ± 8.7 versus 10.7 ± 2.1, P < 0.001; Delta albumin: 11.3 ± 2.5 versus 4.2 ± 1.3, P < 0.001). In the fistuloclysis subgroups, biliary fistula patients had the maximum number of variables with the greatest improvements. Conclusions. Fistuloclysis improved hepatic and nutritional parameters in patients with high-output upper EF, particularly in biliary fistula patients.

Nutritional management of a complicated surgical patient by means of fistuloclysis

“…3 Wu et al found that fistuloclysis could successfully improve liver function and overall nutritional status in patients with high-output enteric fistulae. 2 Ninety-five patients met the entry criteria in this study 2 and were enrolled. They were divided into a control group who received EN only, and a fistuloclysis group who received EN and fistuloclysis.…”

“…2 Benefits seen might be because of the improvement in liver function and nutritional status, together with a reduction in fistula output. 2 Up to 70% of patients with fistulae have malnutrition.…”

“…2 Benefits seen might be because of the improvement in liver function and nutritional status, together with a reduction in fistula output. 2 Up to 70% of patients with fistulae have malnutrition. 1 EN support is the preferred route of nutrition support, unless it increases fistula output dramatically, causes increased abdominal pain or exacerbates diarrhoea.…”

“…2 This may, in part, be attributable to cholecystokinin (CCK) which is produced by the endocrine cells in the duodenum and upper jejunum. 2 CCK stimulates gallbladder contractility and bile secretion. 2 CCK is secreted in response to fat, protein and amino acid in the duodenum.…”

“…1 Enteral nutrition (EN) has considerable advantages over parenteral nutrition (PN) support, including improved gut barrier function, a reduction in infectious morbidity and improved immune function. 2 EN support remains the preferred route of nutrition support in patients with fistulae, unless it causes a significant increase in fistula output, abdominal pain or exacerbates diarrhoea. 1 Fistuloclysis, i.e.…”