Treatment of enterocutaneous fistula: a systematic review and meta-analysis

Gefen, Rachel; Garoufalia, Zoe; Zhou, Peige; Watson, Kathryn; Emile, Sameh Hany; Wexner, Steven D.

doi:10.1007/s10151-022-02656-3

Cited by 15 publications

(26 citation statements)

References 60 publications

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“…The unique results of this thesis defining the population-based incidence of ECF, shows an The percentage of postoperative ECF of 71.7% (IV) is in line with other studies (1,11,16).…”

Section: Incidence Aetiologies and Outcomes Of Enterocutaneous Fistulasupporting

confidence: 90%

“…About 17% originate from the large bowel. A third of the patients have a complex fistula, defined as more than one abnormal connection between the gastrointestinal tract and the skin or fistulae involving multiple bowel loops (1). ECFs are classified by their aetiology, anatomy, and output volume.…”

Section: Background Enterocutaneous Fistulamentioning

confidence: 99%

“…ECF is a complex condition that can be difficult to treat and involves several challenging health problems for the individual affected. In addition to electrolyte and fluid imbalances and malnutrition due to intestinal failure, ECF is associated with infections, fistula-dressing problems, pain, and psychological distress (1,3,5). ECF requires a multidisciplinary approach in which dieticians, enterostomal therapists, specialist nurses, pharmacists, radiologists, physiotherapists, pain specialists, psychiatrists, gastroenterologists, physicians, and surgeons need to work together to meet the patient's needs (5).…”

Section: Society Of Clinical Nutrition and Metabolism (Espen) Guideli...mentioning

confidence: 99%

“…The treatment of ECF must be individualised and depends on the aetiology and characteristics of the ECF and patient-related factors (1). It includes both medical and surgical challenges in which a comprehensive approach is necessary.…”

Section: Medical and Surgical Interventionsmentioning

confidence: 99%

“…It feels like an eternity but the hope of getting rid of the fistula makes it easier to cope with daily life." 1 Enterocutaneous fistula (ECF) is a rare condition with high morbidity and mortality, and it can cause multiple health problems for the individual affected (1). An ECF usually occurs due to a surgical complication, which means that the patient has often undergone major surgery with a complicated postoperative period and has been hospitalised for a long time (2).…”

Section: Introductionmentioning

confidence: 99%

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Enterocutaneous fistula : Patients', families' and healthcare professionals' experiences - epidemiology and outcomes

Härle

2023

Linköping University Medical Dissertations

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Introduction: Enterocutaneous fistula is a rare and complex condition with high morbidity.The condition causes multiple health problems, and it is both physically and psychologically demanding for the affected person and their families. Infection, fistula wound care challenges, electrolyte and fluid imbalance, and malnutrition render the individual in need of long periods of in-hospital care and homecare. This also places great demands on healthcare professionals and knowledge among healthcare professionals can be lacking. The patients have different needs and person-centred care is one way to promote individualised care based on the patient's specific needs. Research about how enterocutaneous fistula affects the individual and their families is scarce, and healthcare professionals often have little experience providing care for these patients. There is also a lack of population-based studies on enterocutaneous fistula.The annual incidence of enterocutaneous fistula was 1.87 per 100.000 persons. Cumulative enterocutaneous fistula related in-hospital care, until closure or end of follow-up, was median 4 (range 0-61) weeks. Thirty-seven per cent of the patients needed parenteral supplementation and 80% needed help with fistula wound care. Home-based healthcare, i.e., fistula wound care, resources for parenteral feeding and access to 24-hour emergency wound care at home, was provided to 42.2% of the patients. Estimated overall mortality at one, three, and five years was 33.7%, 42.1%, and 47.6%, respectively. Mortality was dominated by patients who did not have spontaneous closure of the enterocutaneous fistula or undergo reconstructive surgery.Conclusions: Enterocutaneous fistula is a serious condition with a high overall mortality and the patients need a lot of healthcare resources. The condition restricts the patient's and family's daily life and leads to social isolation and psychological distress. By promoting person-centred care and patient participation, the healthcare professionals can strengthen autonomy in daily life and improve the patient's ability to cope with the situation. Regular team meetings of the multidisciplinary team, careful planning before discharge and providing person-centred care can facilitate the care process for everyone involved.

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“…The unique results of this thesis defining the population-based incidence of ECF, shows an The percentage of postoperative ECF of 71.7% (IV) is in line with other studies (1,11,16).…”

Section: Incidence Aetiologies and Outcomes Of Enterocutaneous Fistulasupporting

confidence: 90%

Section: Background Enterocutaneous Fistulamentioning

confidence: 99%

Section: Society Of Clinical Nutrition and Metabolism (Espen) Guideli...mentioning

confidence: 99%

Section: Medical and Surgical Interventionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Enterocutaneous fistula : Patients', families' and healthcare professionals' experiences - epidemiology and outcomes

Härle

2023

Linköping University Medical Dissertations

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Exploration of critical care nurses' challenges in caring for enterocutaneous fistula as a complication for an open abdomen: A qualitative study

Chipu,

Kearns,

Modula

2024

Health Science Reports

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Background and AimsEnterocutaneous fistula is a severe complication of an open abdomen, which poses devastating challenges for critical care nurses. The study aimed to explore and describe the challenges faced by critical care nurses caring for patients with enterocutaneous fistulas in a tertiary public hospital in Gauteng, South Africa.MethodsA qualitative, exploratory, descriptive, and contextual design was conducted to understand the challenges experienced by the critical care nurses caring for patients with enterocutaneous fistulas. The standards for reporting qualitative research checklists are utilized. The study conducted four semistructured focus group interviews with six members in each group.ResultsCritical care nurses revealed two overarching themes: the challenges regarding difficult nursing care and the lack of resources to provide quality patient care. Care of patients with ECF highlighted that nurses were not coping with the care of such patients.ConclusionCollaboration of a multidisciplinary team involving dieticians, surgeons, and enterostomal therapy nurses could improve the management of ECF without surgical intervention, increase the knowledge and skills of nurses, alleviate their challenges, and yield safe patient outcomes. Standardized and updated protocols will ensure the best practices toward quality patient care that facilitate healing, closure, and reducing mortality and morbidity rates. The key principles for caring for patients with open abdomen, presenting with enterocutaneous fistulas, are based on correcting fluids and electrolytes, nutritional optimization and support, control of abdominal sepsis, wound care management, pain control, and emotional support to critical care nurses and ward nurses.

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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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Treatment of enterocutaneous fistula: a systematic review and meta-analysis

Cited by 15 publications

References 60 publications

Enterocutaneous fistula : Patients', families' and healthcare professionals' experiences - epidemiology and outcomes

Enterocutaneous fistula : Patients', families' and healthcare professionals' experiences - epidemiology and outcomes

Exploration of critical care nurses' challenges in caring for enterocutaneous fistula as a complication for an open abdomen: A qualitative study

Use of parenteral nutrition in the management of enterocutaneous fistula

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