Skip to main content
PMC home page
Gut logoLink to Gut
. 2001 Dec;49(Suppl 4):iv21–iv28. doi: 10.1136/gut.49.suppl_4.iv21

Optimising the treatment of upper gastrointestinal fistulae

I Gonzalez-Pinto, E Gonzalez
PMCID: PMC1766894  PMID: 11878791

Full Text

The Full Text of this article is available as a PDF (162.9 KB).

graphic file with name 00691.f1.jpg

Open in a new tab

Figure 1 Conceptual algorithm for treatment with somatostatin-14. GI, gastrointestinal.

graphic file with name 00691.f2.jpg

Open in a new tab

Figure 2 Somatostatin-14 plus nutritional support (total parenteral nutrition (TPN), enteral nutrition (EN)) may considerably reduce treatment costs.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adotey J. M. External intestinal fistulae in Port Harcourt. West Afr J Med. 1995 Apr-Jun;14(2):97–100. [PubMed] [Google Scholar]
  2. Alexander J. W. Bacterial translocation during enteral and parenteral nutrition. Proc Nutr Soc. 1998 Aug;57(3):389–393. doi: 10.1079/pns19980056. [DOI] [PubMed] [Google Scholar]
  3. Alvarez C., McFadden D. W., Reber H. A. Complicated enterocutaneous fistulas: failure of octreotide to improve healing. World J Surg. 2000 May;24(5):533–538. doi: 10.1007/s002689910086. [DOI] [PubMed] [Google Scholar]
  4. Bade P. G., Thomson S. R., Hirshberg A., Robbs J. V. Surgical options in traumatic injury to the extrahepatic biliary tract. Br J Surg. 1989 Mar;76(3):256–258. doi: 10.1002/bjs.1800760314. [DOI] [PubMed] [Google Scholar]
  5. Baigrie R. J., Devitt P. G., Watkin D. S. Enteral versus parenteral nutrition after oesophagogastric surgery: a prospective randomized comparison. Aust N Z J Surg. 1996 Oct;66(10):668–670. doi: 10.1111/j.1445-2197.1996.tb00714.x. [DOI] [PubMed] [Google Scholar]
  6. Barnes S. M., Kontny B. G., Prinz R. A. Somatostatin analog treatment of pancreatic fistulas. Int J Pancreatol. 1993 Oct;14(2):181–188. doi: 10.1007/BF02786125. [DOI] [PubMed] [Google Scholar]
  7. Beglinger C., Drewe J. Somatostatin and octreotide: physiological background and pharmacological application. Digestion. 1999;60 (Suppl 2):2–8. doi: 10.1159/000051474. [DOI] [PubMed] [Google Scholar]
  8. Berlin R. B., Jr, Javna S. L. Closed suction wide area drainage. Surg Gynecol Obstet. 1992 May;174(5):422–423. [PubMed] [Google Scholar]
  9. Berry S. M., Fischer J. E. Classification and pathophysiology of enterocutaneous fistulas. Surg Clin North Am. 1996 Oct;76(5):1009–1018. doi: 10.1016/s0039-6109(05)70495-3. [DOI] [PubMed] [Google Scholar]
  10. Berry S. M., Fischer J. E. Enterocutaneous fistulas. Curr Probl Surg. 1994 Jun;31(6):469–566. doi: 10.1016/0011-3840(94)90037-x. [DOI] [PubMed] [Google Scholar]
  11. Bivins B. A., Bell R. M., Rapp R. P., Toedebusch W. H. Pancreatic exocrine response to parenteral nutrition. JPEN J Parenter Enteral Nutr. 1984 Jan-Feb;8(1):34–36. doi: 10.1177/014860718400800134. [DOI] [PubMed] [Google Scholar]
  12. Boden G., Sivitz M. C., Owen O. E., Essa-Koumar N., Landor J. H. Somatostatin suppresses secretin and pancreatic exocrine secretion. Science. 1975 Oct 10;190(4210):163–165. doi: 10.1126/science.1166308. [DOI] [PubMed] [Google Scholar]
  13. Campos A. C., Meguid M. M., Coelho J. C. Factors influencing outcome in patients with gastrointestinal fistula. Surg Clin North Am. 1996 Oct;76(5):1191–1198. doi: 10.1016/s0039-6109(05)70507-7. [DOI] [PubMed] [Google Scholar]
  14. Chung M. A., Wanebo H. J. Surgical management and treatment of gastric and duodenal fistulas. Surg Clin North Am. 1996 Oct;76(5):1137–1146. doi: 10.1016/s0039-6109(05)70502-8. [DOI] [PubMed] [Google Scholar]
  15. Coia L. R., Myerson R. J., Tepper J. E. Late effects of radiation therapy on the gastrointestinal tract. Int J Radiat Oncol Biol Phys. 1995 Mar 30;31(5):1213–1236. doi: 10.1016/0360-3016(94)00419-L. [DOI] [PubMed] [Google Scholar]
  16. Davids P. H., Rauws E. A., Tytgat G. N., Huibregtse K. Postoperative bile leakage: endoscopic management. Gut. 1992 Aug;33(8):1118–1122. doi: 10.1136/gut.33.8.1118. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Dearlove J. L. Skin care management of gastrointestinal fistulas. Surg Clin North Am. 1996 Oct;76(5):1095–1109. doi: 10.1016/s0039-6109(05)70499-0. [DOI] [PubMed] [Google Scholar]
  18. Donner C. S. Pathophysiology and therapy of chronic radiation-induced injury to the colon. Dig Dis. 1998 Jul-Aug;16(4):253–261. doi: 10.1159/000016873. [DOI] [PubMed] [Google Scholar]
  19. Dorta G. Role of octreotide and somatostatin in the treatment of intestinal fistulae. Digestion. 1999;60 (Suppl 2):53–56. doi: 10.1159/000051481. [DOI] [PubMed] [Google Scholar]
  20. Dudrick S. J., Maharaj A. R., McKelvey A. A. Artificial nutritional support in patients with gastrointestinal fistulas. World J Surg. 1999 Jun;23(6):570–576. doi: 10.1007/pl00012349. [DOI] [PubMed] [Google Scholar]
  21. Dutta T., Kulshrestha R. Faecal fistulae in children. Prog Pediatr Surg. 1982;15:195–202. [PubMed] [Google Scholar]
  22. Dárdai E., Pirityi S., Nagy L. Parenteral and enteral nutrition and the enterocutaneous fistula treatment. II. Factors influencing the outcome of treatment. Acta Chir Hung. 1991;32(4):305–318. [PubMed] [Google Scholar]
  23. Fazio V. W., Coutsoftides T., Steiger E. Factors influencing the outcome of treatment of small bowel cutaneous fistula. World J Surg. 1983 Jul;7(4):481–488. doi: 10.1007/BF01655937. [DOI] [PubMed] [Google Scholar]
  24. Fischer J. E. The pathophysiology of enterocutaneous fistulas. World J Surg. 1983 Jul;7(4):446–450. doi: 10.1007/BF01655932. [DOI] [PubMed] [Google Scholar]
  25. Foley M. J., Ghahremani G. G., Rogers L. F. Reappraisal of contrast media used to detect upper gastrointestinal perforations: comparison of ionic water-soluble media with barium sulfate. Radiology. 1982 Jul;144(2):231–237. doi: 10.1148/radiology.144.2.7089273. [DOI] [PubMed] [Google Scholar]
  26. Foster C. E., 3rd, Lefor A. T. General management of gastrointestinal fistulas. Recognition, stabilization, and correction of fluid and electrolyte imbalances. Surg Clin North Am. 1996 Oct;76(5):1019–1033. doi: 10.1016/s0039-6109(05)70496-5. [DOI] [PubMed] [Google Scholar]
  27. Galland R. B., Spencer J. Radiation-induced gastrointestinal fistulae. Ann R Coll Surg Engl. 1986 Jan;68(1):5–7. [PMC free article] [PubMed] [Google Scholar]
  28. Güitrón A., Adalid R., Nares J., Albores A. Manejo endoscópico de la fístula biliar. Rev Gastroenterol Mex. 1997 Jan-Mar;62(1):29–33. [PubMed] [Google Scholar]
  29. Hamilton R. F., Davis W. C., Stephenson D. V., Magee D. F. Effects of parenteral hyperalimentation on upper gastrointestinal tract secretions. Arch Surg. 1971 Apr;102(4):348–352. doi: 10.1001/archsurg.1971.01350040110022. [DOI] [PubMed] [Google Scholar]
  30. Hernández-Aranda J. C., Gallo-Chico B., Flores-Ramírez L. A., Avalos-Huante R., Magos-Vázquez F. J., Ramírez-Barba E. J. Tratamiento de las fístulas enterocutáneas con o sin octreótida y nutrición parenteral. Nutr Hosp. 1996 Jul-Aug;11(4):226–229. [PubMed] [Google Scholar]
  31. Ihse I., Larsson J., Lindström E. Surgical management of pure pancreatic fistulas. Hepatogastroenterology. 1994 Jun;41(3):271–275. [PubMed] [Google Scholar]
  32. Irrgang S., Bryant R. Management of the enterocutaneous fistula (continuous education credit). J Enterostomal Ther. 1984 Nov-Dec;11(6):211–228. doi: 10.1097/00152192-198411000-00032. [DOI] [PubMed] [Google Scholar]
  33. Klempa I., Schwedes U., Usadel K. H. Verhütung von postoperativen pankreatitischen Komplikationen nach Duodenopankreatektomie durch Somatostatin. Chirurg. 1979 Jul;50(7):427–431. [PubMed] [Google Scholar]
  34. Kutz K., Nüesch E., Rosenthaler J. Pharmacokinetics of SMS 201-995 in healthy subjects. Scand J Gastroenterol Suppl. 1986;119:65–72. doi: 10.3109/00365528609087433. [DOI] [PubMed] [Google Scholar]
  35. Li S. C., Burton F. R., Burton M. S., Hallett J. The endoscopic diagnosis of iliac colonic fistula and review of literature. Am J Gastroenterol. 1993 Feb;88(2):307–310. [PubMed] [Google Scholar]
  36. Lindberg E., Järnerot G., Huitfeldt B. Smoking in Crohn's disease: effect on localisation and clinical course. Gut. 1992 Jun;33(6):779–782. doi: 10.1136/gut.33.6.779. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Lipsett P. A., Cameron J. L. Internal pancreatic fistula. Am J Surg. 1992 Feb;163(2):216–220. doi: 10.1016/0002-9610(92)90104-y. [DOI] [PubMed] [Google Scholar]
  38. Lévy E., Frileux P., Cugnenc P. H., Honiger J., Ollivier J. M., Parc R. High-output external fistulae of the small bowel: management with continuous enteral nutrition. Br J Surg. 1989 Jul;76(7):676–679. doi: 10.1002/bjs.1800760708. [DOI] [PubMed] [Google Scholar]
  39. McLean G. K., Mackie J. A., Freiman D. B., Ring E. J. Enterocutaneous fistulae: interventional radiologic management. AJR Am J Roentgenol. 1982 Apr;138(4):615–619. doi: 10.2214/ajr.138.4.615. [DOI] [PubMed] [Google Scholar]
  40. Meguid M. M., Campos A. C. Nutritional management of patients with gastrointestinal fistulas. Surg Clin North Am. 1996 Oct;76(5):1035–1080. doi: 10.1016/s0039-6109(05)70497-7. [DOI] [PubMed] [Google Scholar]
  41. Nubiola-Calonge P., Badía J. M., Sancho J., Gil M. J., Segura M., Sitges-Serra A. Blind evaluation of the effect of octreotide (SMS 201-995), a somatostatin analogue, on small-bowel fistula output. Lancet. 1987 Sep 19;2(8560):672–674. doi: 10.1016/s0140-6736(87)92452-4. [DOI] [PubMed] [Google Scholar]
  42. Parekh D., Segal I. Pancreatic ascites and effusion. Risk factors for failure of conservative therapy and the role of octreotide. Arch Surg. 1992 Jun;127(6):707–712. doi: 10.1001/archsurg.1992.01420060083012. [DOI] [PubMed] [Google Scholar]
  43. Patrick C. H., Goodin J., Fogarty J. Complication of prolonged transpyloric feeding: formation of an enterocutaneous fistula. J Pediatr Surg. 1988 Nov;23(11):1023–1024. doi: 10.1016/s0022-3468(88)80014-9. [DOI] [PubMed] [Google Scholar]
  44. Pederzoli P., Bassi C., Falconi M., Albrigo R., Vantini I., Micciolo R. Conservative treatment of external pancreatic fistulas with parenteral nutrition alone or in combination with continuous intravenous infusion of somatostatin, glucagon or calcitonin. Surg Gynecol Obstet. 1986 Nov;163(5):428–432. [PubMed] [Google Scholar]
  45. Planas M., Porta I., Anglés R., Baena J. A., Serra J., Padró J. B. Somatostatina y/o nutrición parenteral total en el tratamiento de las fístulas intestinales. Rev Esp Enferm Dig. 1990 Dec;78(6):345–347. [PubMed] [Google Scholar]
  46. Prinz R. A., Pickleman J., Hoffman J. P. Treatment of pancreatic cutaneous fistulas with a somatostatin analog. Am J Surg. 1988 Jan;155(1):36–42. doi: 10.1016/s0002-9610(88)80255-1. [DOI] [PubMed] [Google Scholar]
  47. Reichlin S. Somatostatin. N Engl J Med. 1983 Dec 15;309(24):1495–1501. doi: 10.1056/NEJM198312153092406. [DOI] [PubMed] [Google Scholar]
  48. Ridgeway M. G., Stabile B. E. Surgical management and treatment of pancreatic fistulas. Surg Clin North Am. 1996 Oct;76(5):1159–1173. doi: 10.1016/s0039-6109(05)70504-1. [DOI] [PubMed] [Google Scholar]
  49. Rolandelli R., Roslyn J. J. Surgical management and treatment of sepsis associated with gastrointestinal fistulas. Surg Clin North Am. 1996 Oct;76(5):1111–1122. doi: 10.1016/s0039-6109(05)70500-4. [DOI] [PubMed] [Google Scholar]
  50. Rolandelli R., Roslyn J. J. Surgical management and treatment of sepsis associated with gastrointestinal fistulas. Surg Clin North Am. 1996 Oct;76(5):1111–1122. doi: 10.1016/s0039-6109(05)70500-4. [DOI] [PubMed] [Google Scholar]
  51. Rombeau J. L., Rolandelli R. H. Enteral and parenteral nutrition in patients with enteric fistulas and short bowel syndrome. Surg Clin North Am. 1987 Jun;67(3):551–571. doi: 10.1016/s0039-6109(16)44232-5. [DOI] [PubMed] [Google Scholar]
  52. Rose D. M., Rose A. T., Chapman W. C., Wright J. K., Lopez R. R., Pinson C. W. Management of bronchobiliary fistula as a late complication of hepatic resection. Am Surg. 1998 Sep;64(9):873–876. [PubMed] [Google Scholar]
  53. Rubelowsky J., Machiedo G. W. Reoperative versus conservative management for gastrointestinal fistulas. Surg Clin North Am. 1991 Feb;71(1):147–157. doi: 10.1016/s0039-6109(16)45339-9. [DOI] [PubMed] [Google Scholar]
  54. Rubin S. C., Benjamin I., Hoskins W. J., Pierce V. K., Lewis J. L., Jr Intestinal surgery in gynecologic oncology. Gynecol Oncol. 1989 Jul;34(1):30–33. doi: 10.1016/0090-8258(89)90100-5. [DOI] [PubMed] [Google Scholar]
  55. Saari A., Schröder T., Kivilaakso E., Kalima T., Lempinen M. Treatment of pancreatic fistulas with somatostatin and total parenteral nutrition. Scand J Gastroenterol. 1989 Sep;24(7):859–862. doi: 10.3109/00365528909089226. [DOI] [PubMed] [Google Scholar]
  56. Saito Y., Tokutake K., Matsuno S., Noto N., Honda T., Sato T. Effects of hypertonic glucose and amino acid infusions on pancreatic exocrine function. Tohoku J Exp Med. 1978 Feb;124(2):99–115. doi: 10.1620/tjem.124.99. [DOI] [PubMed] [Google Scholar]
  57. Sancho J. J., di Costanzo J., Nubiola P., Larrad A., Beguiristain A., Roqueta F., Franch G., Oliva A., Gubern J. M., Sitges-Serra A. Randomized double-blind placebo-controlled trial of early octreotide in patients with postoperative enterocutaneous fistula. Br J Surg. 1995 May;82(5):638–641. doi: 10.1002/bjs.1800820521. [DOI] [PubMed] [Google Scholar]
  58. Schein M. Free perforation of benign gastrojejunocolic and gastrocolic fistula. Report of two cases. Dis Colon Rectum. 1987 Sep;30(9):705–706. doi: 10.1007/BF02561693. [DOI] [PubMed] [Google Scholar]
  59. Scott N. A., Finnegan S., Irving M. H. Octreotide and postoperative enterocutaneous fistulae: a controlled prospective study. Acta Gastroenterol Belg. 1993 May-Aug;56(3-4):266–270. [PubMed] [Google Scholar]
  60. Segal I., Parekh D., Lipschitz J., Gecelter G., Myburgh J. A. Treatment of pancreatic ascites and external pancreatic fistulas with a long-acting somatostatin analogue (Sandostatin). Digestion. 1993;54 (Suppl 1):53–58. doi: 10.1159/000201078. [DOI] [PubMed] [Google Scholar]
  61. Sitges-Serra A., Jaurrieta E., Sitges-Creus A. Management of postoperative enterocutaneous fistulas: the roles of parenteral nutrition and surgery. Br J Surg. 1982 Mar;69(3):147–150. doi: 10.1002/bjs.1800690310. [DOI] [PubMed] [Google Scholar]
  62. Soeters P. B., Ebeid A. M., Fischer J. E. Review of 404 patients with gastrointestinal fistulas. Impact of parenteral nutrition. Ann Surg. 1979 Aug;190(2):189–202. doi: 10.1097/00000658-197908000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  63. Soeters P. B. Gastro-intestinal fistulas: the role of nutritional support. Acta Chir Belg. 1985 May-Jun;85(3):155–162. [PubMed] [Google Scholar]
  64. Spiliotis J., Vagenas K., Panagopoulos K., Kalfarentzos F. Treatment of enterocutaneous fistulas with TPN and somatostatin, compared with patients who received TPN only. Br J Clin Pract. 1990 Dec;44(12):616–618. [PubMed] [Google Scholar]
  65. Stylianos S., Martin E. C., Starker P. M., Laffey K. J., Bixon R., Forde K. A. Percutaneous drainage of intra-abdominal abscesses following abdominal trauma. J Trauma. 1989 May;29(5):584–588. doi: 10.1097/00005373-198905000-00007. [DOI] [PubMed] [Google Scholar]
  66. Thomas H. A. Radiologic investigation and treatment of gastrointestinal fistulas. Surg Clin North Am. 1996 Oct;76(5):1081–1094. doi: 10.1016/s0039-6109(05)70498-9. [DOI] [PubMed] [Google Scholar]
  67. Torres A. J., Landa J. I., Moreno-Azcoita M., Argüello J. M., Silecchia G., Castro J., Hernandez-Merlo F., Jover J. M., Moreno-Gonzales E., Balibrea J. L. Somatostatin in the management of gastrointestinal fistulas. A multicenter trial. Arch Surg. 1992 Jan;127(1):97–100. doi: 10.1001/archsurg.1992.01420010115018. [DOI] [PubMed] [Google Scholar]
  68. Traverso L. W., Abou-Zamzam A. M., Maxwell D. S., Lacy S. M., Tompkins R. K. The effect of total parenteral nutrition or elemental diet on pancreatic proteolytic activity and ultrastructure. JPEN J Parenter Enteral Nutr. 1981 Nov-Dec;5(6):496–500. doi: 10.1177/0148607181005006496. [DOI] [PubMed] [Google Scholar]
  69. Waitzberg D. L., Plopper C., Terra R. M. Postoperative total parenteral nutrition. World J Surg. 1999 Jun;23(6):560–564. doi: 10.1007/pl00012347. [DOI] [PubMed] [Google Scholar]
  70. Warshaw A. L., Swanson R. S. Pancreatic cancer in 1988. Possibilities and probabilities. Ann Surg. 1988 Nov;208(5):541–553. doi: 10.1097/00000658-198811000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  71. Yeo C. J., Cameron J. L., Lillemoe K. D., Sauter P. K., Coleman J., Sohn T. A., Campbell K. A., Choti M. A. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg. 2000 Sep;232(3):419–429. doi: 10.1097/00000658-200009000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  72. Yeo C. J., Cameron J. L., Sohn T. A., Lillemoe K. D., Pitt H. A., Talamini M. A., Hruban R. H., Ord S. E., Sauter P. K., Coleman J. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997 Sep;226(3):248–260. doi: 10.1097/00000658-199709000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  73. Yeo C. J. Management of complications following pancreaticoduodenectomy. Surg Clin North Am. 1995 Oct;75(5):913–924. doi: 10.1016/s0039-6109(16)46736-8. [DOI] [PubMed] [Google Scholar]
  74. Ysebaert D., Van Hee R., Hubens G., Vaneerdeweg W., Eyskens E. Management of digestive fistulas. Scand J Gastroenterol Suppl. 1994;207:42–44. doi: 10.3109/00365529409104194. [DOI] [PubMed] [Google Scholar]
  75. Zinner M. J., Baker R. R., Cameron J. L. Pancreatic cutaneous fistulas. Surg Gynecol Obstet. 1974 May;138(5):710–712. [PubMed] [Google Scholar]
  76. di Costanzo J., Cano N., Martin J., Richieri J. P., Mercier R., Lafille C., Lepeuch D. Treatment of external gastrointestinal fistulas by a combination of total parenteral nutrition and somatostatin. JPEN J Parenter Enteral Nutr. 1987 Sep-Oct;11(5):465–470. doi: 10.1177/0148607187011005465. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES