Nutritional Management and Strategies for the Enterocutaneous Fistula

Purpose of Review Enterocutaneous Fistula (ECF) management remains a complex medical problem. Under best circumstances morbidity and mortality remains high. Best practice for nutrition management has remained stagnant since the development of parenteral nutrition by the late Stanley Dudrick in the 1960-1970s. This manuscript proposes that the old paradigm of exclusive parenteral nutrition for high output fistulas (> 500 cc/day) is antiquated and should be aborted based on contemporary evidence. Recent Findings Through the development of modern management protocols for nutritional optimization, pre-habilitation of this patient population may become more efficient and impact morbidity and mortality in a positive manner. A review of the literature and inferences from other bodies of surgical management helps impact ECF care. Enhanced recovery after surgery will likely be the future for ECF patient, but outcomes of more randomized control trials studying ECF management must help guide the future.