Newsletter

[ Vol. 9 No. 3 ] (September - December 2008 )
Nutritional support in gastrointestinal fistulas

Jianan Ren M.D.
Research Institute of General Surgery,
JinlingHospital, Nanjing University, Jiangsu 210002, P.R. of China

Nutritional supports including parenteral and enteral nutrition play a key role in the management of Gastrointestinal fistula patients. Malnutrition is very common among the patients complicated with gastrointestinal patients because of hyper-metabolism induced by stress such as sepsis and injury and intestinal dysfunction. The optimal route of nutritional support is determined by the general strategy of reaching closure of gastrointestinal fistula. Different large specialist centers have resulted in a variety of different management strategies.

Promoting spontaneous closure of fistula is the first choice. To reach this purpose, total parenteral nutrition should be given to reduce the fistula output and somatostatin may be given initially to further reduce the fistula output. When the fistula output could be controlled, enteral nutrition could be given and recombinant human growth hormone may be added to promote rapid spontaneous closure of fistula.

Surgical intervention is need if the fistula remains open after 2 months. Whenever it is found the fistula could not close spontaneously and surgery is needed, enteral nutrition should be considered to maintain long term waiting for the surgery. The specific techniques for the implementation of enteral feeding include patch patching method, fistuloclysis as well as the routine nasal gastric or nasal jejunal tube feeding. Enteral nutrition could be given incase of suspect of intestinal barrier damage and bacterial translocation to prevent repeat sepsis. In the perioperative period, total parenteral nutrition (TPN) should be given until the recovery of intestinal function. In selected cases, early definitive operation could be performed within two weeks of operation that induce fistula. In this case, TPN may be given longer then routine definitive surgery.

From  
The 12^th PENSA Congress
October 18-20 2007, Century Park Hotel. Manila, Philippines 
Page: 32