Fistuloclysis: Cost Effective Nutrition for Patients with Enterocutaneous Fistulae

摘要

This manuscript highlights the financial benefits derived from fistuloclysis when used for nutrient delivery in patients with enterocutaneous fistulae. Introduction Enterocutaneous Fistulae (ECF) may be challenging to manage because large volume fistula losses may result in severe dehydration, electrolyte imbalances, malnutrition and sepsis (1). Recognizing and correcting these complications are prerequisites to successful ECF management.Nutritional support is especially important because malnutrition is an independent predictor of post-operative morbidity and mortality regardless of age, cardiorespiratory function or operation type (2,3). Central vein parenteral nutrition (PN) is used liberally while awaiting spontaneous ECF closure or optimizing patients for operation (1,4). But it carries the risk of electrolyte derangements, metabolic disturbances, catheter related complications and sepsis (5,6). Moreover, the cost of prolonged PN may limit its availability in Developing Countries.Fistuloclysis is a viable alternative in select patients, thereby avoiding PN and its attendant complications (4,7). The technique was initially described by Teubner et al who delivered enteral feeds directly into a balloon retention gastrostomy tube passed 5cm into the distal limb of an ECF (4). In their report, fistuloclysis successfully replaced PN in 11 of 12 patients within 28 days of commencement (4).