Kumpf VJ, de Aguilar-Nascimento JE, Diaz-Pizarro Graf JI, Hall AM, McKeever L, Steiger E, Winkler MF, Compher CW, FELANPE., American Society for Parenteral and Enteral Nutrition., et al.
JPEN. Journal of parenteral and enteral nutrition. Date of publication 2017 Jan 1;volume 41(1):104-112.
1. JPEN J Parenter Enteral Nutr. 2017 Jan;41(1):104-112. doi:
10.1177/0148607116680792. Epub 2016 Dec 5.
ASPEN-FELANPE Clinical Guidelines.
Kumpf VJ(1), de Aguilar-Nascimento JE(2), Diaz-Pizarro Graf JI(3), Hall AM(4),
McKeever L(5), Steiger E(6), Winkler MF(7), Compher CW(8); FELANPE; American
Society for Parenteral and Enteral Nutrition.
Author information:
(1)1 Vanderbilt University Medical Center, Nashville, Tennessee, USA.
(2)2 UNIVAG Medical School, Cuiaba, Brazil.
(3)3 Anáhuac University and Hospital Angeles Lomas, Mexico City, Huixquilucan,
Mexico.
(4)4 Boston Children's Hospital, Boston, Massachusetts, USA.
(5)5 University of Illinois at Chicago, Chicago, Illinois, USA.
(6)6 Cleveland Clinic Lerner College of Medicine of Case Western Reserve
University and Cleveland Clinic, Cleveland, Ohio, USA.
(7)7 Alpert Medical School of Brown University and Rhode Island Hospital,
Providence, Rhode Island, USA.
(8)8 University of Pennsylvania, Philadelphia, Pennsylvania, USA.
BACKGROUND: The management of patients with enterocutaneous fistula (ECF)
requires an interdisciplinary approach and poses a significant challenge to
physicians, wound/stoma care specialists, dietitians, pharmacists, and other
nutrition clinicians. Guidelines for optimizing nutrition status in these
patients are often vague, based on limited and dated clinical studies, and
typically rely on individual institutional or clinician experience. Specific
nutrient requirements, appropriate route of feeding, role of immune-enhancing
formulas, and use of somatostatin analogues in the management of patients with
ECF are not well defined. The purpose of this clinical guideline is to develop
recommendations for the nutrition care of adult patients with ECF.
METHODS: A systematic review of the best available evidence to answer a series of
questions regarding clinical management of adults with ECF was undertaken and
evaluated using concepts adopted from the Grading of Recommendations, Assessment,
Development, and Evaluation (GRADE) Working Group. An anonymous consensus process
was used to develop the clinical guideline recommendations prior to peer review
and approval by the ASPEN Board of Directors and by FELANPE.
QUESTIONS: In adult patients with enterocutaneous fistula: (1) What factors best
describe nutrition status? (2) What is the preferred route of nutrition therapy
(oral diet, enteral nutrition, or parenteral nutrition)? (3) What protein and
energy intake provide best clinical outcomes? (4) Is fistuloclysis associated
with better outcomes than standard care? (5) Are immune-enhancing formulas
associated with better outcomes than standard formulas? (6) Does the use of
somatostatin or somatostatin analogue provide better outcomes than standard
medical therapy? (7) When is home parenteral nutrition support indicated?
DOI: 10.1177/0148607116680792
PMID: 27913762 [Indexed for MEDLINE]
