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Enterocutaneous fistula

Key sources
The following summarized guidelines for the evaluation and management of enterocutaneous fistula are prepared by our editorial team based on guidelines from the American Society of Colon and Rectal Surgeons (ASCRS 2020), the British Society of Gastroenterology (BSG 2019), the American College of Gastroenterology (ACG 2018), and the Latin American Federation of Nutritional Therapy, Clinical Nutrition and Metabolism (FELANPE/ASPEN 2017).


1.Diagnostic investigations

Nutritional evaluation: assess patients with ECF for malnutrition at the time of diagnosis. Obtain periodic nutrition assessment if malnutrition is not present at baseline as patients with fistulas have a high likelihood of becoming malnourished due to nutrient malabsorption, fluid and electrolyte losses, and sepsis.
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2.Medical management

Immunosuppressive therapy: as per BSG 2019 guidelines, consider initiating immunomodulator and biological therapy for the management of patients with IBD and low volume ECFs.
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3.Nonpharmacologic interventions

Nutritional support: consider initiating oral diet or enteral nutrition after stabilization of fluid and electrolyte balance in adult patients with low-output (< 500 mL/day) ECF (suggesting no distal obstruction). Consider initiating parenteral nutrition to meet fluid, electrolyte, and nutrient requirements to support spontaneous or surgical closure of the ECF in patients with high-output fistula (> 500 mL/day).
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4.Surgical interventions

Indications for surgery: as per ASCRS 2020 guidelines, consider performing surgery in patients withCrohn's disease and enteric fistulas persisting despite appropriate medical therapy.