Spontaneous Closure of Enterocutaneous Fistula: Total Parenteral Nutrition Compared to Enteral Nutrition. A Review of the Evidence.

Clinical Question: In adults with enterocutaneous fistulas, does nil per os status and total parenteral nutrition result in spontaneous closure of the fistula compared to enteral nutrition?

Answer: No. TPN and bowel rest have not been proven to directly facilitate spontaneous fistula closure. Given the inherent complications of TPN and the benefits of EN, EN should be utilized as early as possible in the nutritional management of ECF patients, sparing TPN for when EN is contraindicated or as a bridge until EN can be tolerated by the patient. More studies are needed to directly compare rates of spontaneous ECF closure with TPN vs. EN.