Teduglutide for the treatment of low-output enterocutaneous fistula – A pilot randomized controlled study

Yeh, D. Dante; Vasileiou, Georgia; Jawad, Khaled Abdul; Pust, Gerd Daniel; Byers, Patricia

doi:10.1016/j.clnesp.2022.04.031

Cited by 3 publications

(2 citation statements)

References 28 publications

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“…Previous randomized control trials have demonstrated significant improvements in parenteral nutrition dependence in this patient population [32,33]. Recently, a pilot randomized controlled trial was performed on patients with ECF [34]. This study focused on low output fistula patients as defined as less than 200 ml/day which had been present for a median 7.5 (range 2-24) months.…”

Section: Adjuncts and Innovations In Enteric Fistula Managementmentioning

confidence: 99%

Current fistula management

Vanzant,

Thompson,

Mendoza

et al. 2024

Current Opinion in Critical Care

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Purpose of review Enterocutaneous fistulas (ECFs) pose a significant impact in the healthcare system, both financially and in resource utilization. Delivery of optimal care is complex and involves intensive wound care, complex nutritional delivery and multidisciplinary care teams for optimization. Recently, there have been pushes to modernize the traditional approach to ECF care to a new paradigm of protocol-based individualized delivery of care. Recent findings There is an increased trend towards pushing enteral nutrition for the management of ECF patients. Adjuncts, including improved fistuloclysis devices, supplements and absorptive aides have challenged the conventional dogma of ECF treatment. There has also been increased focus on surgical prehabilitation and the ability to improve patient outcomes. Summary ECF care is complex and requires a multidisciplinary approach focused on source control, nutritional optimization with focus on enteral nutrition, wound care and prehabilitation.

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Section: Adjuncts and Innovations In Enteric Fistula Managementmentioning

confidence: 99%

Current fistula management

Vanzant,

Thompson,

Mendoza

et al. 2024

Current Opinion in Critical Care

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“…Esta enfermedad está asociada con estancias hospitalarias prolongadas y altos costos para el sistema sanitario. La primera serie relevante acerca de fístula enterocutánea en el Hospital General de Massachusetts en 1960, informó una tasa de mortalidad del 44 % 8 . Avances recientes basados en el apoyo nutricional, metabólico, cuidado de heridas y mejor técnica quirúrgica, han resultado en disminución de la mortalidad al 5-15 % 9 .…”

Section: Epidemiologíaunclassified

Fístula enterocutánea: un enfoque desde las generalidades y el estado nutricional

Castrillón-Lozano,

Bonilla-Vergara,

Rivera-Pérez

2023

Rev Colomb Cir

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Introducción. Una fístula es una conexión anormal entre dos superficies epitelizadas. Cerca del 80 % de las fístulas entero-cutáneas son de origen iatrogénico secundarias a cirugía, y un menor porcentaje se relacionan con traumatismos, malignidad, enfermedad inflamatoria intestinal o isquemia. La morbilidad y las complicaciones asociadas pueden ser significativas, como la desnutrición, en la que intervienen múltiples factores. Métodos. Se realizó una búsqueda de la literatura en las bases de datos de PubMed, Google Scholar y SciELO, utilizando las palabras claves descritas y se seleccionaron los artículos más relevantes de los últimos años. Resultados. La clasificación de las fístulas se basa en su anatomía, su gasto o secreción diaria y su localización. Existe una tríada clásica de las complicaciones: sepsis, desnutrición y anomalías electrolíticas. El control del gasto de la fístula, el drenaje adecuado de las colecciones y la terapia antibiótica son claves en el manejo precoz de estos pacientes. Los estudios recientes hacen hincapié en que la sepsis asociada con la desnutrición son las principales causas de mortalidad. Conclusiones. Esta condición representa una de las complicaciones de más difícil y prolongado tratamiento en cirugía abdominal y colorrectal, y se relaciona con importantes tasas de morbilidad, mortalidad y altos costos para el sistema de salud. Es necesario un tratamiento multidisciplinario basado en la reanimación con líquidos, el control de la sepsis, el soporte nutricional y el cuidado de la herida, entre otros factores.

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Use of parenteral nutrition in the management of enterocutaneous fistula

Kumpf,

Yeh

2024

Nut in Clin Prac

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Nutrition plays an integral role in the management of patients with enterocutaneous fistula (ECF), but practice guidelines are often vague because of limited evidence. As a result, clinicians must rely on expert consensus and sound nutrition principles to guide practice. The initial phase of ECF management involves recognition (eg, fistula location and quantifying output) and stabilization (eg, source control and fluid and electrolyte balance). All patients with ECF should be considered at risk of malnutrition because of malabsorption, high gastrointestinal fluid and nutrient losses, and chronic inflammation. Strict bowel rest in conjunction with parenteral nutrition (PN) is typically warranted on initial presentation, but patients can often transition to oral diet or enteral nutrition if ECF output is low (<500 ml/day) and there is good control of ECF drainage at the skin level. Patients with high‐output ECF (>500 ml/day) may require PN to meet fluid, electrolyte, and nutrient requirements to support spontaneous or surgical closure of the ECF. Because the healing process can take months, transfer from the inpatient to home setting should be considered when a patient is medically stable. Preparing for discharge home requires stabilization of fluid and electrolyte balance, achievement of glycemic control, containment of ECF output, and patient and/or caregiver training. A long‐term PN treatment plan should be developed that incorporates outpatient monitoring, determination of target weight, and desired PN end point. The purpose of this article is to review the optimal use of PN in adult patients with ECF.

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Teduglutide for the treatment of low-output enterocutaneous fistula – A pilot randomized controlled study

Cited by 3 publications

References 28 publications

Current fistula management

Current fistula management

Fístula enterocutánea: un enfoque desde las generalidades y el estado nutricional

Use of parenteral nutrition in the management of enterocutaneous fistula

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