Table 1.

Treatment principles in the bridging-to-surgery period derived from the ESCP consensus statement1

Recommendation	Level of evidence
Type 2 IF (>28 days) should be treated in a multidisciplinary IF unit	4
Reconstructive surgery should not be undertaken for 6–12 months and until nutrition has been optimized, and preferably after a patient has had a period of time at home. A few parameters of optimizing are rising albumin levels (preferably >32 g/L), resolution of sepsis, good fluid and electrolyte balance, and stable or increasing weight.	4
Patients should be allowed to take liquids and diet as early as possible and as tolerated unless the surgeon feels that withholding oral intake may reduce peritoneal contamination and provide the best chance of spontaneous closure immediately after fistula formation	5
Specific nutrient deficiencies need to be monitored with regular measurements of magnesium, zinc, selenium, iron, vitamins D, K, B12 in those requiring prolonged nutritional support, particularly if there are difficulties with oral magnesium and phosphate supplementation with a high-output stoma/fistula.	4
High-dose loperamide, proton pump inhibitors, and codeine phosphate should be used to reduce fistula or stoma output. There is little evidence to support the routine use of somatostatin analogues or cholestyramine in the management of high output stoma or intestinal fistula.	4