Nutrition Support of Adult Patients With Enterocutaneous Fistula

Publication Date: December 2, 2016
Last Updated: March 14, 2022


We suggest the following:
  • Malnutrition be diagnosed by nutrition history, including unintentional weight loss and estimation of energy/nutrient intake, and physical examination.
  • Assessment for malnutrition be conducted at the time of diagnosis of an ECF. If malnutrition is not present at baseline, periodic nutrition assessment is warranted as patients with fistulas have a high likelihood of becoming malnourished due to nutrient malabsorption, fluid and electrolyte losses, and sepsis.
  • Serum protein concentrations be obtained prior to and during nutrition therapy since they are prognostic outcome indicators, yet are not sensitive nutrition markers.
(, VL - Very Low)

After stabilization of fluid and electrolyte balance, we suggest that oral diet or EN may be feasible and tolerated in patients with low-output (<500 mL/d) ECF (suggesting no distal obstruction). However, patients with high-output ECF (>500 mL/d) may require PN to meet fluid, electrolyte, and nutrient requirements to support spontaneous or surgical closure of the ECF. (, VL - Very Low)

Based on expert consensus, we suggest the provision of protein at 1.5–2.0 g/kg/d and energy intake appropriate to the patient’s energy requirements based on results of nutrition assessment. More protein may be required (up to 2.5 g/kg/d) in patients with enteroatmospheric fistula and high fistula output. (, )

(Based on consensus only, as no recent evidence was available.)


  • We suggest the use of fistuloclysis for nutrition therapy for patients with intact intestinal absorptive capability distal to the infusion site and when the infusion ECF site is not expected to close spontaneously.
  • We suggest the use of polymeric formulas initially and change to semi-elemental (oligomeric) diet if intolerance occurs.
(, VL - Very Low)

We cannot recommend multicomponent immune-enhancing formulas to improve outcomes of ECF due to lack of evidence. We suggest that oral glutamine in addition to PN may improve mortality and fistula closure rates. (, VL - Very Low)

We recommend use of somatostatin analogue in adult patients with high-output (>500 mL/d) ECF as a method to reduce effluent drainage and enhance spontaneous closure. (, M - Moderate)

Based on expert consensus, we suggest consideration of HPN when the patient is medically stable and the fistula output is manageable, as well as in patients with high-output ECF (>500 mL/d) when surgical repair is not yet advised. (, )

(Based on consensus only, as no recent evidence was available.)


Recommendation Grading




Nutrition Support of Adult Patients With Enterocutaneous Fistula

Authoring Organization

Publication Month/Year

December 2, 2016

Last Updated Month/Year

June 2, 2023

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Male, Adult

Health Care Settings

Emergency care, Hospital, Long term care

Intended Users

Medical assistant, dietician nutritionist, nurse, nurse practitioner, physician, physician assistant



Diseases/Conditions (MeSH)

D018529 - Nutritional Support, D017577 - Cutaneous Fistula


Nutrition Support , Enterocutaneous Fistula, inflamed bowel

Supplemental Methodology Resources

Data Supplement


Number of Source Documents
Literature Search Start Date
January 1, 1995
Literature Search End Date
June 1, 2016