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Valderrama OM, Quiodettis MA, Monteza S. Effectiveness of Fistuloclysis in Nutritional Management of Enteroatmospheric Fistulas: A Retrospective Study at Santo Tomás Hospital, Panama. Cureus 2024; 16:e59403. [PMID: 38817490 PMCID: PMC11139537 DOI: 10.7759/cureus.59403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction Enteroatmospheric fistulas (EAF) present significant challenges in surgical management due to their complex nature and high mortality rate. Traditional approaches often rely on prolonged parenteral nutrition, but emerging evidence suggests the potential benefits of enteral nutrition via fistuloclysis, an underappreciated enteral nutrition route. This study aims to evaluate the effectiveness of nutritional therapy, specifically fistuloclysis, in patients with EAF managed at the Trauma Unit of Santo Tomás Hospital, Panama. Methods A retrospective analysis was conducted on nine male patients diagnosed with EAF between January 2016 and December 2020. Data on demographics, fistula characteristics, and nutritional management were collected through chart review. Descriptive statistics were used for analysis. Results We analyzed nine patients, all of whom received enteral nutrition (EN) via fistuloclysis in a median of 5.5 days from the diagnosis of EAF. Seven patients required parenteral nutrition (PN) at the beginning. The use of specialized enteral formulas, supplemented with hydrolyzed proteins and medium-chain triglycerides, facilitated discontinuation of PN once 80% of nutritional requirements were met via the enteral route, and EN was continued until definitive surgery. The median duration of PN was 34 days. No adverse effects related to EN were observed, whereas complications such as central venous catheter infections were reported in all cases requiring PN. Conclusion Fistuloclysis is a viable and effective alternative to traditional PN in patients with EAF. Specialized nutritional strategies, including the use of semi-elemental formulas, contribute to improved outcomes and reduced complications. Early initiation and gradual increase in enteral nutrition via fistuloclysis demonstrate safety and efficacy, underscoring the importance of tailored nutritional approaches in optimizing patient care for complex surgical conditions.
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Liao Y, Tao S, Yao Z, Tian W, Xu X, Zhao R, Zhao Y, Huang Q. Chyme reinfusion improved outcomes after definitive surgery for small‐intestinal enteroatmospheric fistula in patients with enteral nutrition. Nutr Clin Pract 2022; 37:634-644. [PMID: 35094427 DOI: 10.1002/ncp.10823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Yannian Liao
- Medical College of Nanjing University Nanjing Jiangsu China
| | - Shen Tao
- Department of General Surgery Nanjing 83 Hospital Nanjing Jiangsu China
| | - Zheng Yao
- Department of Enterocutaneous Fistula Surgery Jiangning Hospital Nanjing Jiangsu China
| | - Weiliang Tian
- Department of General Surgery Jinling Hospital Nanjing Jiangsu China
| | - Xin Xu
- Department of Enterocutaneous Fistula Surgery Jiangning Hospital Nanjing Jiangsu China
| | - Risheng Zhao
- Department of Enterocutaneous Fistula Surgery Jiangning Hospital Nanjing Jiangsu China
| | - Yunzhao Zhao
- Department of Enterocutaneous Fistula Surgery Jiangning Hospital Nanjing Jiangsu China
- Department of General Surgery Jinling Hospital Nanjing Jiangsu China
| | - Qian Huang
- Department of General Surgery Jinling Hospital Nanjing Jiangsu China
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Ribeiro-Junior MAF, Yeh DD, Augusto SDS, Elias YGB, Néder PR, Costa CTK, Maurício AD, Saverio SD. THE ROLE OF FISTULOCLYSIS IN THE TREATMENT OF PATIENTS WITH ENTEROATMOSPHERIC FISTULAS. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2021; 34:e1605. [PMID: 34669893 PMCID: PMC8521894 DOI: 10.1590/0102-672020210002e1605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/08/2021] [Indexed: 11/22/2022]
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.
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Affiliation(s)
| | - Daniel Dante Yeh
- Division of Trauma and Surgical Critical Care, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | | | - Paola Rezende Néder
- Medical College, University Santo Amaro Medical School, São Paulo, SP, Brazil
| | | | | | - Salomone Di Saverio
- Department of General Surgery, University of Insubria, Regione Lombardia, Varese, Italy
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4
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Xu X, Cai L, Tian W, Yao Z, Zhao R, Zhao Y. Effects of different preoperative enteral nutrition feeding routes on the duration of gastrointestinal decompression after definitive surgery for small intestinal fistula. Langenbecks Arch Surg 2021; 406:2837-2848. [PMID: 34398262 DOI: 10.1007/s00423-021-02301-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/09/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study is to investigate the effects of different preoperative enteral nutrition feeding routes on the duration of gastrointestinal decompression after definitive surgery for small intestinal fistula. METHODS From January 2015 to June 2019, patients with small intestinal fistula and receiving a definitive surgery were enrolled. According to the feeding route, patients were divided into a nasointestinal tube group and a nasogastric tube group. Clinical characteristics of the two groups were analyzed, and the influence of the two route on the recovery of gastrointestinal function was evaluated. RESULT A total of 151 patients were enrolled in our study. There were 49 patients in the nasogastric tube group, and 102 patients in the nasointestinal tube group. Enteral nutrition via nasogastric feeding route had a positive effect on shortening the duration of gastrointestinal decompression (adjusted HR = 2.488, 95% CI: 1.692-3.659, P < 0.001). After propensity matching (PM), 44 patients were enrolled (22 vs 22). EN via nasogastric tube was a positive factor for getting rid of gastrointestinal decompression (adjusted HR = 3.563, 95% CI: 1.639-7.746, P = 0.001). CONCLUSION Preoperative enteral nutrition via nasogastric route can reduce the duration of gastrointestinal decompression after definitive surgery for small intestinal fistula.
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Affiliation(s)
- Xin Xu
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China
| | - Lina Cai
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China
| | - Weiliang Tian
- Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu, China
| | - Zheng Yao
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China. .,Department of Enterocutaneous Fistula Surgery, Jiangning Hospital, Hushan Road No. 169, Nanjing, Jiangsu, China.
| | - Risheng Zhao
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China. .,Department of Enterocutaneous Fistula Surgery, Jiangning Hospital, Hushan Road No. 169, Nanjing, Jiangsu, China.
| | - Yunzhao Zhao
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China.,Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu, China
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Sobocki J, Jackowski M, Dziki A, Tarnowski W, Banasiewicz T, Kunecki M, Słodkowski M, Stanisławski M, Zaczek Z, Richer P, Matyja A, Frączek M, Wallner G. Clinical guidelines for the management of gastrointestinal fistula
– developed by experts of the Polish Surgical Society. POLISH JOURNAL OF SURGERY 2021. [DOI: 10.5604/01.3001.0015.0499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction: Gastrointestinal fistula is one of the most difficult problems in gastrointestinal surgery. It is associated with high morbidity and mortality, numerous complications, prolonged hospitalization, and high cost of treatment. </br>Aim: This project aimed to develop recommendations for the treatment of gastrointestinal fistulas, based on evidence-based medicine and best clinical practice to reduce treatment-related mortality and morbidity. </br>Material and methods: The preparation of these recommendations is based on a review of the literature from the PubMed, Medline, and Cochrane Library databases from 1.01.2010 to 31.12.2020, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. Recommendations in the form of a directive were formulated and assessed using the Delphi method. </br>Results and conclusions: Nine recommendations were presented along with a discussion and comments of experts. Treatment should be managed by a multidisciplinary team (surgeon, anesthetist, clinical nutritionist/dietician, nurse, pharmacist, endoscopist).
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Affiliation(s)
- Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Postgraduate Medical Education Center, Warsaw, Poland; Head: Jacek Sobocki MD PhD, CMPK Professor
| | - Marek Jackowski
- Department of General Surgery, Gastrointestinal Surgery and Surgical Oncology, Collegium Mediucm at the Nicolaus Copernicus University in Torun, Poland; Head: prof. Marek Jackowski MD PhD
| | - Adam Dziki
- Department of General and Colorectal Surgery, Medical University of Lodz, Poland; Head: prof. Adam Dziki MD PhD
| | - Wiesław Tarnowski
- Department of General Surgery, Gastrointestinal Surgery and Surgical Oncology, Postgraduate Medical Education Center, Warsaw, Poland; Head: prof. Wiesław Tarnowski MD PhD
| | - Tomasz Banasiewicz
- Department of General Surgery, Endocrine Surgery and Gastrointestinal Oncology, Institute of Surgery, Poznan University of Medical Sciences, Poland; Head: prof. Tomasz Banasiewicz MD PhD
| | - Marek Kunecki
- General and Vascular Surgery Unit, Center for Nutritional Therapy, M. Pirogow Regional Specialist Hospital, Lodz, Poland; Head: Marek Kunecki MD PhD
| | - Maciej Słodkowski
- Department of General Surgery, Gastrointestinal Surgery and Surgical Oncology, Medical University of Warsaw, Poland; Head: Maciej Słodkowski MD PhD
| | - Michał Stanisławski
- Department of General Surgery and Clinical Nutrition, Postgraduate Medical Education Center, Warsaw, Poland; Head: Jacek Sobocki MD PhD, CMPK Professor
| | - Zuzanna Zaczek
- Department of General Surgery and Clinical Nutrition, Postgraduate Medical Education Center, Warsaw, Poland; Head: Jacek Sobocki MD PhD, CMPK Professor
| | - Piotr Richer
- Department and Clinical Unit of General Surgery, Gastrointestinal Surgery and Transplantology, Jagiellonian University Medical College, Cracow, Poland; Head: prof. Piotr Richter MD PhD
| | - Andrzej Matyja
- II Department of Surgery, Clinical Unit of General Surgery, Surgical Oncology, Metabolic Surgery and Emergency Surgery, Jagiellonian University Medical College, Cracow, Poland; Head: prof. Andrzej Matyja, MD PhD
| | - Mariusz Frączek
- II Department and Clinic of General Surgery, Vascular Surgery and Surgical Oncology at the Medical University of Warsaw, Poland; Head: prof. Mariusz Frączek MD PhD
| | - Grzegorz Wallner
- II Department and Clinic of General Surgery, Gastrointestinal Surgery and Gastrointestinal Neoplasia, Medical University of Lublin, Poland; Head: prof. Grzegorz Wallner MD PhD
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Solis E, Wright DB, O'Grady G, Ctercteko G. Chyme reinfusion nutritional management for enterocutaneous fistula: first international application of a novel pump technique. Colorectal Dis 2021; 23:1924-1929. [PMID: 33742548 DOI: 10.1111/codi.15643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/16/2021] [Accepted: 02/27/2021] [Indexed: 12/13/2022]
Abstract
AIM High-output enterocutaneous fistulas (ECFs) are an established cause of intestinal failure. Parenteral nutrition (PN) remains the gold standard for nutritional management but is complex, expensive and associated with significant complications. Chyme reinfusion (CR) has been reported by multiple centres as a viable option for nutritional management that improves nutritional status, provides the capacity to cease PN and is cost-effective. The aim of this paper is to describe the first use of a novel pump device (The Insides System™) by an independent centre in Australia for the nutritional management of a patient with high-output ECF. METHOD CR was performed on a 66-year-old woman with a high-output ECF. The device consists of two main components: a centrifugal pump that sits inside the stoma appliance and a battery-powered driver that is magnetically coupled externally onto the pump. The device allows for bolus CR at a rate of infusion that is manually controlled by the patient based on comfort, volume and effluent viscosity. RESULTS CR provided adequate nutritional support, with successful cessation of PN. Effective use of the device was learnt easily by the patient with minimal demands on nursing assistance. Side effects of CR (diarrhoea, abdominal cramping) were overcome by the patient's ability to manually adjust the reinfusion rate. CONCLUSION Our experience with the novel Insides System™ device showed promising results in maintaining nutritional status as well as providing a minimally invasive, easy to use and low-cost system for CR. CR should be considered as a viable alternative for the nutritional management of patients with a high-output ECF.
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Affiliation(s)
- Edgardo Solis
- Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,Discipline of Surgery, Westmead Clinical School, the Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Danette B Wright
- Department of Surgery, Blacktown and Mount Druitt Hospital, Blacktown, New South Wales, Australia
| | - Greg O'Grady
- Department of Surgery, Auckland University, Auckland, New Zealand.,The Insides Company, Auckland, New Zealand.,Auckland Bioengineering Institute, Auckland, New Zealand
| | - Grahame Ctercteko
- Department of Colorectal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
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7
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De Luis Román D, Domínguez Medina E, Molina Baena B, Matía-Martín P. Oligomeric Formulas in Surgery: A Delphi and Consensus Study. Nutrients 2021; 13:nu13061922. [PMID: 34205024 PMCID: PMC8227417 DOI: 10.3390/nu13061922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 01/04/2023] Open
Abstract
Nutritional management of patients with intestinal failure often includes the use of oligomeric formulas. Implementing the use of oligomeric formulas in surgical patients with maldigestion or malabsorption could be a nutritional strategy to be included in clinical protocols. We aim to generate knowledge from a survey focused on the effectiveness of nutritional therapy with oligomeric formulas with Delphi methodology. Each statement that reached an agreement consensus among participants was defined as a median consensus score ≥7 and as an interquartile range ≤3. The use of oligomeric formulas in surgical patients, starting enteral nutrition in the post-operative phase in short bowel syndrome and in nonspecific diarrhea after surgical procedures, could improve nutritional therapy implementation. Stakeholders agreed that early jejunal enteral nutrition with oligomeric formula is more effective compared to intravenous fluid therapy and it is useful in patients undergoing upper gastro-intestinal tract major surgery when malabsorption or maldigestion is suspected. Finally, oligomeric formulas may be useful when a feeding tube is placed distally to the duodenum. This study shows a practical approach to the use of oligomeric formulas in surgical patients with intestinal disorders and malabsorption, and it helps clinicians in the decision-making process.
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Affiliation(s)
- Daniel De Luis Román
- Center of Investigation Endocrinology and Nutrition, Hospital Clínico Universitario de Valladolid, Medicine School University, 47002 Valladolid, Spain;
| | - Eduardo Domínguez Medina
- Center for Research in Molecular Medicine and Chronic Diseases (CiMUS), 15782 Santiago de Compostela, Spain;
| | | | - Pilar Matía-Martín
- Endocrinology and Nutrition Unit, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
- Correspondence: ; Tel.: +34-639851411
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8
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Hu Y, Yang DY. Interventional ultrasound and contrast-enhanced ultrasound in the diagnosis of small intestine-iliopsoas fistula: A case report. J Dig Dis 2021; 22:230-233. [PMID: 33713048 DOI: 10.1111/1751-2980.12981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 02/10/2021] [Accepted: 03/08/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Yue Hu
- Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Dong Yan Yang
- Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
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9
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Fousekis FS, Mitselos IV, Christodoulou DK. New insights into intestinal failure-associated liver disease in adults: A comprehensive review of the literature. Saudi J Gastroenterol 2021; 27:3-12. [PMID: 33642350 PMCID: PMC8083246 DOI: 10.4103/sjg.sjg_551_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Intestinal failure-associated liver disease (IFALD) remains one of the most common and serious complications of parenteral nutrition (PN), causing a wide spectrum of hepatic manifestations from steatosis and mild cholestasis to portal hypertension and end-stage liver failure. The prevalence of IFALD depends on the diagnostic criteria and ranges from 4.3% to 65%. Moreover, many factors are shown to contribute to its development, including nutrient deficiencies, toxicity of PN, infections, and alterations of bile acid metabolism and gut microbiota. Prevention and management of IFALD aim at ameliorating or eliminating the risk factors associated with IFALD. The use of PN formulations with a lower ratio omega-6-to-omega-3 polyunsaturated fatty acids, cycle PN, optimization of enteral stimulation and prevention and early treatment of infections constitute the main therapeutic targets. However, failure of improvement and severe IFALD with end-stage liver failure should be considered as the indications of intestinal transplantation. The aim of this review is to provide an update of the epidemiology, pathophysiology, and diagnosis of IFALD in the adult population as well as to present a clinical approach of the therapeutic strategies of IFALD and present novel therapeutic targets.
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Affiliation(s)
- Fotios S. Fousekis
- Department of Gastroenterology and Hepatology, School of Health Sciences, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Ioannis V. Mitselos
- Department of Gastroenterology and Hepatology, School of Health Sciences, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Dimitrios K. Christodoulou
- Department of Gastroenterology and Hepatology, School of Health Sciences, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, Ioannina, Greece,Address for correspondence: Prof. Dimitrios K. Christodoulou, Professor of Gastroenterology, Department of Gastroenterology and Hepatology, School of Health Sciences, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, POBox 1186, Ioannina 45110, Greece. E-mail:
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10
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Tang QQ, Hong ZW, Ren HJ, Wu L, Wang GF, Gu GS, Chen J, Zheng T, Wu XW, Ren JA, Li JS. Nutritional Management of Patients With Enterocutaneous Fistulas: Practice and Progression. Front Nutr 2020; 7:564379. [PMID: 33123545 PMCID: PMC7573310 DOI: 10.3389/fnut.2020.564379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/07/2020] [Indexed: 12/14/2022] Open
Abstract
The management of enterocutaneous fistulas (ECF) can be challenging because of massive fluid loss, which can lead to electrolyte imbalance, severe dehydration, malnutrition and sepsis. Nutritional support plays a key role in the management and successful closure of ECF. The principle of nutritional support for patients with ECF should be giving enteral nutrition (EN) priority, supplemented by parenteral nutrition if necessary. Although total parenteral nutrition (TPN) may be indicated, use of enteral feeding should be advocated as early as possible if patients are tolerant to it, which can protect gut mucosal barrier and prevent bacterial translocation. A variety of methods of enteral nutrition have been developed such as fistuloclysis and relay perfusion. ECF can also be occluded by special devices and then EN can be implemented, including fibrin glue application, Over-The-Scope Clip placement and three-dimensional (3D)-printed patient-personalized fistula stent implantation. However, those above should not be conducted in acute fistulas, because tissues are edematous and perforation could easily occur.
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Affiliation(s)
- Qin-Qing Tang
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China.,Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhi-Wu Hong
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Hua-Jian Ren
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Lei Wu
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Ge-Fei Wang
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Guo-Sheng Gu
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Jun Chen
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Tao Zheng
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Xiu-Wen Wu
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Jian-An Ren
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Jie-Shou Li
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
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11
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Picot D, Layec S, Seynhaeve E, Dussaulx L, Trivin F, Carsin-Mahe M. Chyme Reinfusion in Intestinal Failure Related to Temporary Double Enterostomies and Enteroatmospheric Fistulas. Nutrients 2020; 12:nu12051376. [PMID: 32403450 PMCID: PMC7285017 DOI: 10.3390/nu12051376] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 12/13/2022] Open
Abstract
Some temporary double enterostomies (DES) or entero-atmospheric fistulas (EAF) have high output and are responsible for Type 2 intestinal failure. Intravenous supplementations (IVS) for parenteral nutrition and hydration compensate for intestinal losses. Chyme reinfusion (CR) artificially restores continuity pending surgical closure. CR treats intestinal failure and is recommended by European Society for Clinical Nutrition and Metabolism (ESPEN) and American Society for Parenteral and Enteral Nutrition (ASPEN) when possible. The objective of this study was to show changes in nutritional status, intestinal function, liver tests, IVS needs during CR, and the feasibility of continuing it at home. A retrospective study of 306 admitted patients treated with CR from 2000 to 2018 was conducted. CR was permanent such that a peristaltic pump sucked the upstream chyme and reinfused it immediately in a tube inserted into the downstream intestine. Weight, plasma albumin, daily volumes of intestinal and fecal losses, intestinal nitrogen, and lipid absorption coefficients, plasma citrulline, liver tests, and calculated indices were compared before and during CR in patients who had both measurements. The patients included 185 males and 121 females and were 63 ± 15 years old. There were 37 (12%), 269 (88%) patients with EAF and DES, respectively. The proximal small bowel length from the duodeno-jejunal angle was 108 ± 67 cm (n = 232), and the length of distal small intestine was 117 ± 72 cm (n = 253). The median CR start was 5 d (quartile 25-75%, 2-10) after admission and continued for 64 d (45-95), including 81 patients at home for 47 d (28-74). Oral feeding was exclusive 171(56%), with enteral supplement 122 (42%), or with IVS 23 (7%). Before CR, 211 (69%) patients had IVS for nutrition (77%) or for hydration (23%). IVS were stopped in 188 (89%) 2 d (0-7) after the beginning of CR and continued in 23 (11%) with lower volumes. Nutritional status improved with respect to weight gain (+3.5 ± 8.4%) and albumin (+5.4 ± 5.8 g/L). Intestinal failure was cured in the majority of cases as evidenced by the decrease in intestinal losses by 2096 ± 959 mL/d, the increase in absorption of nitrogen 32 ± 20%, of lipids 43 ± 30%, and the improvement of citrulline 13.1 ± 8.1 µmol/L. The citrulline increase was correlated with the length of the distal intestine. The number of patients with at least one liver test >2N decreased from 84-40%. In cases of Type 2 intestinal failure related to DES or FAE with an accessible and functional distal small bowel segment, CR restored intestinal functions, reduced the need of IVS by 89% and helped improve nutritional status and liver tests. There were no vital complications or infectious diarrhea described to date. CR can become the first-line treatment for intestinal failure related to double enterostomy and high output fistulas.
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12
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Li X, Wei J, Zhang Y, Wang W, Wu G, Zhao Q, Li X. Open abdomen treatment for complicated intra-abdominal infection patients with gastrointestinal fistula can reduce the mortality. Medicine (Baltimore) 2020; 99:e19692. [PMID: 32311946 PMCID: PMC7220662 DOI: 10.1097/md.0000000000019692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
To evaluate the effect of the open abdomen (OA) and closed abdomen (CA) approaches for treating intestinal fistula with complicated intra-abdominal infection (IFWCIAI), and analyze the risk factors in OA treatment.IFWCIAI is associated with high mortality rates and healthcare costs, as well as longer postoperative hospital stay. However, OA treatment has also been linked with increased mortality and development of secondary intestinal fistula.A total of 195 IFWCIAI patients who were operated over a period of 7 years at our hospital were retrospectively analyzed. These patients were divided into the OA group (n = 112) and CA group (n = 83) accordingly, and the mortality rates, hospital costs, and hospital stay duration of both groups were compared. In addition, the risk factors in OA treatment were also analyzed.OA resulted in significantly lower mortality rates (9.8% vs 30.1%, P < .001) and hospital costs ($11721.40 ± $9368.86 vs $20365.36 ± $21789.06, P < .001) compared with the CA group. No incidences of secondary intestinal fistula was recorded and the duration of hospital stay was similar for both groups (P = .151). Delayed OA was an independent risk factor of death following OA treatment (hazard ratio [HR] = 1.316; 95% confidence interval [CI] = 1.068-1.623, P = .010), whereas early enteral nutrition (EN) exceeding 666.67 mL was a protective factor (HR = 0.996; 95% CI = 0.993-0.999, P = .018). In addition, Acinetobacter baumannii, Pseudomonas aeruginosa, and Candida albicans were the main pathogens responsible for the death of patients after OA treatment.OA decreased mortality rates and hospital costs of IFWCIAI patients, and did not lead to any secondary fistulas. Early OA and EN also reduced mortality rates.
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Affiliation(s)
- Xuzhao Li
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University
- Department of General surgery, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750002, Ningxia Hui Autonomous Region, China
| | - Jiangpeng Wei
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University
| | - Ying Zhang
- Department of Radiotherapy, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi
| | - Weizhong Wang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University
| | - Guosheng Wu
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University
| | - Qingchuan Zhao
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University
| | - Xiaohua Li
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University
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13
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Method for Establishing Continuous Reinfusion of Succus Entericus in Complex High-output Fistula. Surg Laparosc Endosc Percutan Tech 2020; 30:227-232. [PMID: 31977971 DOI: 10.1097/sle.0000000000000757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To establish a continuous reinfusion of succus entericus and enteral nutrition (EN) in complex high-output fistula (HOF). Percutaneous puncture and catheterization technique was used to establish continuous reinfusion of succus entericus and EN in complex HOF. From May 2010 to June 2018, 21 patients with complex HOF used continuous reinfusion of succus entericus and EN. Six of them were completely cured, and 15 cases were cured after definitive surgery. Percutaneous puncture and catheterization technique was shown to be a useful and effective method for establishing continuous reinfusion of succus entericus and EN in patients with complex HOF. This method can prevent succus entericus loss and remove the barrier to implementing EN in HOF.
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14
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ASPEN-FELANPE Clinical Guidelines: Nutrition Support of Adult Patients with Enterocutaneous Fistula. NUTR HOSP 2020; 37:875-885. [DOI: 10.20960/nh.03116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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15
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Bhat S, Sharma P, Cameron NR, Bissett IP, O'Grady G. Chyme Reinfusion for Small Bowel Double Enterostomies and Enteroatmospheric Fistulas in Adult Patients: A Systematic Review. Nutr Clin Pract 2019; 35:254-264. [PMID: 31549468 DOI: 10.1002/ncp.10417] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND High-output double enterostomies (DESs) and enteroatmospheric fistulas (EAFs) of the small bowel account for substantial patient morbidity and mortality. Management may include parenteral nutrition (PN) and prolonged admissions, at high cost. Reinfusion of chyme into the distal bowel is a proposed therapeutic alternative when the distal DES limb is accessible; however, standardized information on this technique is required. This review aimed to critically assess the literature regarding chyme reinfusion (CR) to define its current status and future directions. METHODS A systematic search of medical databases was conducted for articles investigating CR in adults. Articles reporting indications, methods, benefits, technical issues, and complications resulting from CR were reviewed. A narrative synthesis of the retrieved data was undertaken. RESULTS In total, 24 articles reporting 481 cases of CR were identified, although articles were heterogeneous in their structure and reporting. CR was most frequently performed for remediation of high-output DES and intestinal failure and for proximally located DES. Effluent output collection was commonly manual, with distal reinfusion more commonly automated, and with few dedicated systems. Multiple benefits attributed to CR were reported, encompassing weight gain, cessation of PN, and improvements in liver function. Technical problems included distaste, labor-intensive methods, reflux of contents, and tube dislodgement. No serious AEs or mortality directly attributable to CR were reported. CONCLUSIONS CR appears to be a promising, safe and well-validated intervention for small bowel DES and EAF. However, more efficient and acceptable methods are required to promote greater adoption of the practice of CR.
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Affiliation(s)
- Sameer Bhat
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Puja Sharma
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Nelle-Rose Cameron
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Ian P Bissett
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Greg O'Grady
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
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16
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Niu DG, Yang F, Tian WL, Zhao YZ, Li C, Ding LA, Fang HC, Huang Q. A technique to establish fistuloclysis for high-output jejunocutaneous fistula through percutaneous enterostomy: A case report. Medicine (Baltimore) 2019; 98:e14653. [PMID: 30855454 PMCID: PMC6417508 DOI: 10.1097/md.0000000000014653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Currently, fistucolysis helps to establish intestinal nutrition and succus entericus reinfusion in the case of controllable mature high-output enterocutaneous fistula. However, if the tube cannot reach the distal limb of a fistula, fistuloclysis is not achieved. We proposed a strategy to establish succus entericus reinfusion for intractable intestinal fistula through percutaneous enterostomy. PATIENT CONCERNS A 43-year-old man was transferred to our facility for postoperative enterocutaneous fistulae, sepsis, malnutrition, and electrolyte and fluid imbalance. The contrast X-ray demonstrated the breakdown of the primary anastomosis, with fistula output ranging from 1500 to 2000 mL/d, despite the administration of medications to reduce gastrointestinal secretions. DIAGNOSES The patient was diagnosed with high-output anastomosis fistula by gastrointestinal radiography. INTERVENTIONS We used percutaneous enterostomy to establish fistuloclysis. OUTCOMES Fistuloclysis was established by percutaneous enterostomy successfully. No complications were found during the past 4-month follow-up after percutaneous enterostomy. He is waiting for reconstruction surgery after 6 months' enteral nutrition (EN). LESSONS Fistuloclysis-assisted EN, if used appropriately, avoids the complications of long-term parenteral nutrition (PN) and may promote faster fistula healing.
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Affiliation(s)
- Dong-Guang Niu
- Gastrointestinal Surgery Department, Affiliated Hospital of Qingdao University, Shandong, China
| | - Fan Yang
- Department of General Surgery, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wei-Liang Tian
- Department of General Surgery, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yun-Zhao Zhao
- Department of General Surgery, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chen Li
- Oncology Department, Xintai People's Hospital, Tai’an, Shandong, China
| | - Lian-An Ding
- Gastrointestinal Surgery Department, Affiliated Hospital of Qingdao University, Shandong, China
| | - Hong-Chun Fang
- Gastrointestinal Surgery Department, Affiliated Hospital of Qingdao University, Shandong, China
| | - Qian Huang
- Department of General Surgery, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
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17
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Enteral nutrition improves clinical outcome and reduces costs of acute mesenteric ischaemia after recanalisation in the intensive care unit. Clin Nutr 2019; 38:398-406. [DOI: 10.1016/j.clnu.2017.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/19/2017] [Accepted: 12/13/2017] [Indexed: 12/31/2022]
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18
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Lal S, Pironi L, Wanten G, Arends J, Bozzetti F, Cuerda C, Joly F, Kelly D, Staun M, Szczepanek K, Van Gossum A, Schneider SM. Clinical approach to the management of Intestinal Failure Associated Liver Disease (IFALD) in adults: A position paper from the Home Artificial Nutrition and Chronic Intestinal Failure Special Interest Group of ESPEN. Clin Nutr 2018; 37:1794-1797. [PMID: 30017241 DOI: 10.1016/j.clnu.2018.07.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/03/2018] [Indexed: 12/30/2022]
Abstract
We recommend that intestinal failure associated liver disease (IFALD) should be diagnosed by the presence of abnormal liver function tests and/or evidence of radiological and/or histological liver abnormalities occurring in an individual with IF, in the absence of another primary parenchymal liver pathology (e.g. viral or autoimmune hepatitis), other hepatotoxic factors (e.g. alcohol/medication) or biliary obstruction. The presence or absence of sepsis should be noted, along with the duration of PN administration. Abnormal liver histology is not mandatory for a diagnosis of IFALD and the decision to perform a liver biopsy should be made on a case-by-case basis, but should be particularly considered in those with a persistent abnormal conjugated bilirubin in the absence of intra or extra-hepatic cholestasis on radiological imaging and/or persistent or worsening hyperbilirubinaemia despite resolution of any underlying sepsis and/or any clinical or radiological features of chronic liver disease. Nutritional approaches aimed at minimising PN overfeeding and optimising oral/enteral nutrition should be instituted to prevent and/or manage IFALD. We further recommend that the lipid administered is limited to less than 1 g/kg/day, and the prescribed omega-6/omega-3 PUFA ratio is reduced wherever possible. For patients with any evidence of progressive hepatic fibrosis or overt liver failure, combined intestinal and liver transplantation should be considered.
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Affiliation(s)
- Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Stott Lane, Salford, M6 8HD, UK; University of Manchester, Manchester, UK.
| | - Loris Pironi
- Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Geert Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jann Arends
- Department of Medicine, Oncology and Hematology, University of Freiburg, Germany
| | | | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Francisca Joly
- Centre for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Darlene Kelly
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Michael Staun
- Rigshospitalet, Department of Gastroenterology, Copenhagen, Denmark
| | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - Andre Van Gossum
- Medico-Surgical Department of Gastroenterology, Hôpital Erasme, Free University of Brussels, Belgium
| | - Stephane Michel Schneider
- Gastroenterology and Clinical Nutrition, CHU of Nice, University of Nice Sophia Antipolis, Nice, France
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19
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Distal Bowel Re-feeding in Patients with Proximal Jejunostomy. J Gastrointest Surg 2018; 22:1251-1257. [PMID: 29777456 DOI: 10.1007/s11605-018-3752-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/17/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients who have a proximal jejunostomy are difficult to manage because of their high stoma output which results in fluid and electrolyte imbalance with repeated hospital admissions and the necessity for expensive parenteral nutrition (PN). There are few reports on the use of re-feeding of the proximal effluents in this situation. METHODS We here relate our experience with this manoeuvre in 35 patients between Jan 2010 and Feb 2016 who had stomas less than 120 cm away from the duodenojejunal flexure. RESULTS There were 26 males and 9 females, whose median age was 47 (19-74) years. The most common indications for massive bowel resection were gangrene in 25 (71%) and intestinal perforation in 7 (20%). The median proximal and distal small bowel lengths were 45 (15-120) cm and 90 (0-240) cm respectively. The ileocaecal (IC) valve was preserved in 33 (94%) and there was only colon distally (without the ileocaecal valve) in 2 (6%) patients. Twenty-five (71%) patients required post-operative ICU care. Additional PN was required in 6 (17%) patients during their index admission with the average extra cost of treatment being 20,000 rupees. Their median hospital stay was 13 (6-60) days. Patients were discharged without intravenous (IV) lines. Eight (26%) patients required re-admission for acute renal failure which was managed conservatively. No major problems were associated with re-feeding. None of the patients required PN after discharge from hospital. Thirty (86%) patients had their stomas closed at 65 (14-224) days. Both the patients with colon only as their distal bowel remnant died. Sepsis was the cause of mortality in 4 (11%) during index admission and 3 after their discharge. On follow-up after bowel re-connection, 2 patients died after 1 and 12 months, both due to intracranial bleeding, and the overall survival was 74%. CONCLUSIONS Patients with proximal jejunostomies can be managed with distal re-feeding. It is a cost-effective and effective substitute for PN, is associated with few problems, and has a fairly good long-term outcome.
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20
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Koelfat KV, Visschers RG, Hodin CM, de Waart DR, van Gemert WG, Cleutjens JP, Gijbels MJ, Shiri-Sverdlov R, Mookerjee RP, Lenaerts K, Schaap FG, Steven W.M. OD. FXR agonism protects against liver injury in a rat model of intestinal failure-associated liver disease. J Clin Transl Res 2017; 3:318-327. [PMID: 30895273 PMCID: PMC6426251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intestinal failure-associated liver disease (IFALD) is a clinical challenge. The pathophysiol-ogy is multifactorial and remains poorly understood. Disturbed recirculation of bile salts, e.g. due to loss of bile via an enterocutaneous fistula, is considered a major contributing factor. We hypothesize that impaired signaling via the bile salt receptor FXR underlies the development of IFALD. The aim of this study was to investigate whether activation of FXR improves liver homeostasis during chronic loss of bile in rats. METHODS To study consequences of chronic loss of bile, rats underwent external biliary drainage (EBD) or sham surgery for seven days, and the prophylactic potential of the FXR agonist INT-747 was assessed. RESULTS EBD for 7 days resulted in liver test abnormalities and histological liver damage. Expression of the intestinal FXR target gene Fgf15 was undetectable after EBD, and this was accompanied by an anticipated increase in hepatic Cyp7a1 expression, indicating increased bile salt synthesis. Treatment with INT-747 improved serum biochemistry, reduced loss of bile fluid in drained rats and prevented development of drainage-associated histological liver injury. CONCLUSIONS EBD results in extensive hepatobiliary injury and cholestasis. These data suggest that FXR activation might be a novel therapy in preventing liver dysfunction in patients with intestinal failure. RELEVANCE FOR PATIENTS This study demonstrates that chronic loss of bile causes liver injury in rats. Abro-gated recycling of bile salts impairing of enterohepatic bile salt/FXR signaling underlies these pathological changes, as administration of FXR agonist INT747 prevents biliary drainage-induced liver damage. Phar-macological activation of FXR might be a therapeutic strategy to treat disorders accompanied by a per-turbed enterohepatic circulation such as intestinal failure-associated liver disease.
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Affiliation(s)
- Kiran V.K. Koelfat
- 1 Department of Surgery, Maastricht University Medical Center,
Maastricht University, NUTRIM School of Nutrition and Translational Research in
Me-tabolism, Maastricht, the Netherlands
| | - Ruben G.J. Visschers
- 1 Department of Surgery, Maastricht University Medical Center,
Maastricht University, NUTRIM School of Nutrition and Translational Research in
Me-tabolism, Maastricht, the Netherlands
| | - Caroline M.J.M. Hodin
- 1 Department of Surgery, Maastricht University Medical Center,
Maastricht University, NUTRIM School of Nutrition and Translational Research in
Me-tabolism, Maastricht, the Netherlands
| | - D. Rudi de Waart
- 2 Tytgat Institute for Liver and Intestinal Research, Academic
Medical Center, Amsterdam, the Netherlands
| | - Wim G. van Gemert
- 1 Department of Surgery, Maastricht University Medical Center,
Maastricht University, NUTRIM School of Nutrition and Translational Research in
Me-tabolism, Maastricht, the Netherlands
| | - Jack P.M. Cleutjens
- 3 Department of Pathology, Maastricht University Medical Center,
Maastricht, the Netherlands
| | - Marion J. Gijbels
- 3 Department of Pathology, Maastricht University Medical Center,
Maastricht, the Netherlands,4 Department of Medical Biochemistry, Academic Medical Center,
Amsterdam, the Netherlands
| | - Ronit Shiri-Sverdlov
- 5 Department of Molecular Genetics, Maastricht University,
Maastricht, the Netherlands
| | - Rajeshwar P. Mookerjee
- 6 Institute for Liver and Digestive Health, University College
London, London, United Kingdom
| | - Kaatje Lenaerts
- 1 Department of Surgery, Maastricht University Medical Center,
Maastricht University, NUTRIM School of Nutrition and Translational Research in
Me-tabolism, Maastricht, the Netherlands
| | - Frank G. Schaap
- 1 Department of Surgery, Maastricht University Medical Center,
Maastricht University, NUTRIM School of Nutrition and Translational Research in
Me-tabolism, Maastricht, the Netherlands,7 Department of Visceral- and Transplantation Surgery, RWTH
Aachen University, Germany
| | - Olde Damink Steven W.M.
- 1 Department of Surgery, Maastricht University Medical Center,
Maastricht University, NUTRIM School of Nutrition and Translational Research in
Me-tabolism, Maastricht, the Netherlands,7 Department of Visceral- and Transplantation Surgery, RWTH
Aachen University, Germany
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21
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Chyme reinfusion in patients with intestinal failure due to temporary double enterostomy: A 15-year prospective cohort in a referral centre. Clin Nutr 2017; 36:593-600. [DOI: 10.1016/j.clnu.2016.04.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 04/10/2016] [Accepted: 04/11/2016] [Indexed: 01/22/2023]
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22
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Ortiz LA, Zhang B, McCarthy MW, Kaafarani HMA, Fagenholz P, King DR, De Moya M, Velmahos G, Yeh DD. Treatment of Enterocutaneous Fistulas, Then and Now. Nutr Clin Pract 2017; 32:508-515. [PMID: 28358595 DOI: 10.1177/0884533617701402] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND An enterocutaneous fistula (ECF) is an aberrant connection between the gastrointestinal tract and the skin or atmosphere (enteroatmospheric fistula [EAF]). Multimodal treatment includes surgical procedures, nutrition support, and wound care. We evaluated our practice and compared our outcomes with previous results published from our institution. MATERIALS AND METHODS We performed a retrospective analysis of hospitalized ECF/EAF patients admitted between January 2011 and November 2015. Patients with internal fistulas; active inflammatory bowel disease; malignancy; radiation treatment; end-stage renal, hepatic, or cardiac disease; and active alcoholism were excluded. Data collected included demographics, fistula characteristics, nutrition therapy, treatment, operative success, and hospital mortality. Parametric and nonparametric tests for independent and paired groups were performed. RESULTS Thirty-one patients were included in the analysis. The median (interquartile range) age was 60 (53-76) years, and 81% were female. Parenteral nutrition was initially prescribed in 80% of patients, but 61% received enteral nutrition (EN) at some point during their hospitalization. Two patients were fed by fistuloclysis. Eighty percent of the patients underwent surgical repair a median of 12 months after diagnosis with 92% operative success. Surgical repair had a modest correlation with home discharge (ρ = 0.517, P = .003). A large proportion of patients (77%) were discharged home. The in-hospital mortality at our institution decreased from 44% in 1960 to 21% in 1970 to 3% in the current study. CONCLUSIONS Modern treatment of ECF/EAF, including EN and advanced local wound care, is associated with improvements in clinical outcomes such as hospital mortality.
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Affiliation(s)
- Luis Alfonso Ortiz
- 1 Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Boston, Massachusetts, USA
| | - Bin Zhang
- 2 Massachusetts General Hospital, Department of Pharmacy, Boston, Massachusetts, USA
| | - Maureen Walsh McCarthy
- 3 Massachusetts General Hospital, Department of General Surgery, Boston, Massachusetts, USA
| | - Haytham M A Kaafarani
- 1 Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Boston, Massachusetts, USA
| | - Peter Fagenholz
- 1 Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Boston, Massachusetts, USA
| | - David R King
- 1 Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Boston, Massachusetts, USA
| | - Marc De Moya
- 1 Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Boston, Massachusetts, USA
| | - George Velmahos
- 1 Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Boston, Massachusetts, USA
| | - Daniel Dante Yeh
- 1 Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Boston, Massachusetts, USA
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23
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Kumpf VJ, de Aguilar-Nascimento JE, Diaz-Pizarro Graf JI, Hall AM, McKeever L, Steiger E, Winkler MF, Compher CW. ASPEN-FELANPE Clinical Guidelines. JPEN J Parenter Enteral Nutr 2016; 41:104-112. [PMID: 27913762 DOI: 10.1177/0148607116680792] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The management of patients with enterocutaneous fistula (ECF) requires an interdisciplinary approach and poses a significant challenge to physicians, wound/stoma care specialists, dietitians, pharmacists, and other nutrition clinicians. Guidelines for optimizing nutrition status in these patients are often vague, based on limited and dated clinical studies, and typically rely on individual institutional or clinician experience. Specific nutrient requirements, appropriate route of feeding, role of immune-enhancing formulas, and use of somatostatin analogues in the management of patients with ECF are not well defined. The purpose of this clinical guideline is to develop recommendations for the nutrition care of adult patients with ECF. METHODS A systematic review of the best available evidence to answer a series of questions regarding clinical management of adults with ECF was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group. An anonymous consensus process was used to develop the clinical guideline recommendations prior to peer review and approval by the ASPEN Board of Directors and by FELANPE. QUESTIONS In adult patients with enterocutaneous fistula: (1) What factors best describe nutrition status? (2) What is the preferred route of nutrition therapy (oral diet, enteral nutrition, or parenteral nutrition)? (3) What protein and energy intake provide best clinical outcomes? (4) Is fistuloclysis associated with better outcomes than standard care? (5) Are immune-enhancing formulas associated with better outcomes than standard formulas? (6) Does the use of somatostatin or somatostatin analogue provide better outcomes than standard medical therapy? (7) When is home parenteral nutrition support indicated?
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Affiliation(s)
- Vanessa J Kumpf
- 1 Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Amber M Hall
- 4 Boston Children's Hospital, Boston, Massachusetts, USA
| | - Liam McKeever
- 5 University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ezra Steiger
- 6 Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and Cleveland Clinic, Cleveland, Ohio, USA
| | - Marion F Winkler
- 7 Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island, USA
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Abstract
With advances in abdominal surgery and the management of major trauma, complex abdominal wall defects have become the new surgical disease, and the need for abdominal wall reconstruction has increased dramatically. Subsequently, how to reconstruct these large defects has become a new surgical question. While most surgeons use native abdominal wall whenever possible, evidence suggests that synthetic or biologic mesh needs to be added to large ventral hernia repairs. One particular group of patients who exemplify "complex" are those with contaminated wounds, enterocutaneous fistulas, enteroatmospheric fistulas, and/or stoma(s), where synthetic mesh is to be avoided if at all possible. Most recently, biologic mesh has become the new standard in high-risk patients with contaminated and dirty-infected wounds. While biologic mesh is the most common tissue engineered used in this field of surgery, level I evidence is needed on its indication and long-term outcomes. Various techniques for reconstructing the abdominal wall have been described, however the long-term outcomes for most of these studies, are rarely reported. In this article, I outline current practical approaches to perioperative management and definitive abdominal reconstruction in patients with complex abdominal wall defects, with or without fistulas, as well as those who have lost abdominal domain.
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25
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Thibault R, Picot D. Chyme reinfusion or enteroclysis in nutrition of patients with temporary double enterostomy or enterocutaneous fistula. Curr Opin Clin Nutr Metab Care 2016; 19:382-387. [PMID: 27367494 DOI: 10.1097/mco.0000000000000304] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Patients with double temporary enterostomy or enterocutaneous fistula may suffer from intestinal failure. Parenteral nutrition is the gold standard treatment until surgical re-establishment of intestinal continuity, but serious complications may arise. Chyme reinfusion or enteroclysis are indicated. RECENT FINDINGS Chyme reinfusion corrects the intestinal failure by restoring intestinal absorption, allowing parenteral nutrition weaning in 91% of patients. Chyme reinfusion contributes to improve nutritional status and reduce plasma liver test abnormalities. Chyme reinfusion is feasible at home without any serious complications in selected patients. Mechanisms underlying chyme reinfusion effectiveness on intestinal function, such as restoration of ileal brake, are suggested but most remain to be demonstrated. When the downstream small bowel is exposed, enteroclysis of enteral nutrition or hydration could be helpful to reduce parenteral nutrition needs, or in case of insufficient food intake during chyme reinfusion. SUMMARY Chyme reinfusion or enteroclysis are less expensive, well tolerated, and easy-to-use nutrition support techniques, which may allow reducing parenteral nutrition-related healthcare costs. The latter remains to be demonstrated in the setting of a prospective randomized controlled trial. This review may contribute to improve the awareness of intensivists, digestive surgeons, and gastroenterologists involved in intestinal failure management to spread the use of chyme reinfusion or enteroclysis.
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Affiliation(s)
- Ronan Thibault
- aNutrition Unit, Department of Endocrinology, Diabetology and Nutrition, Home Parenteral Nutrition Centre, CHU Rennes, Université de Rennes 1, INSERM U991 bDepartment of Nutritional and Digestive Rehabilitation, Clinique Saint Yves, Rennes, France
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Du Toit A. Nutritional management of a complicated surgical patient by means of fistuloclysis. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2016. [DOI: 10.1080/16070658.2014.11734515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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