Overview
Enterocutaneous fistulae (ECFs) are abnormal connections between the gastrointestinal tract and the skin, often leading to significant clinical challenges and healthcare costs 1.Diagnosis
Imaging studies (CT, MRI) for anatomical delineation 1
Endoscopic evaluation to assess fistula origin and extent 1
Laboratory tests including inflammatory markers (CRP) and nutritional status (albumin) 2
Thyroid function tests to screen for nonthyroidal illness syndrome (NTIS) 2Management
First-line treatments: Nutritional support, wound care, and medical management of underlying causes 13
Interventional radiology: Embolization, stent placement, or other minimally invasive procedures for closure when conventional methods fail 1
Vivasorb: Exclusive enteral nutrition showing promising results in spontaneous fistula closure 3
Surgical intervention: Reserved for cases unresponsive to conservative and interventional approaches 1Special Populations
Comorbidities: Patients with NTIS have worse clinical outcomes, including prolonged ICU stays and higher mortality rates 2Key Recommendations
Employ a multidisciplinary approach including interventional radiology for complex ECFs 1 (Evidence: Strong)
Consider exclusive enteral nutrition with Vivasorb in selected cases to avoid risks of prolonged parenteral nutrition 3 (Evidence: Moderate)
Monitor thyroid function tests to identify and manage nonthyroidal illness syndrome in ECF patients 2 (Evidence: Moderate)References
1 Rahman FN, Stavas JM. Interventional radiologic management and treatment of enterocutaneous fistulae. Journal of vascular and interventional radiology : JVIR 2015. link
2 Han G, Ren J, Liu S, Gu G, Ren H, Yan D et al.. Nonthyroidal illness syndrome in enterocutaneous fistulas. American journal of surgery 2013. link
3 Bodvall B, Kylberg F. The use of vivasorb in the treatment of enterocutaneous fistulae. Infusionstherapie und klinische Ernahrung. Sonderheft 1975. link