Management of digestive tract fistulas - A review

Digestive tract fistulas are a complex subject in terms both of classificat ion and management. There is still a lack of firm epidemiological data rega rding the their incidence, though the prognostic factors conditioning the p rognosis of these patients are now well known. They are related mainly to t he nutritional status of the patients and to the presence or otherwise of s epsis. Instrumental investigations should be aimed not merely at identifyin g the complication, but also at guiding clinicians in their choice of thera peutic management. According to the various situations arising, the treatme nt will be surgical, endoscopic or conservative medical. In the latter case , the clinician should establish first of all whether, as a result of the s ite of the fistula or the nutritional status, the patient requires total pa renteral or enteral artificial nutrition, whenever possible. In those cases in which parenteral nutrition is indicated, the ideal drug with the best p roven ability to shorten healing times and reduce the number of complicatio ns when used in combination with parenteral nutrition is naturally occurrin g somatostatin at the dose of 250 mu g/h over 24 h. In all other cases, if the fistula is clinically important, its synthetic analogue, octreotide, sh ould be the drug of choice and can be administered subcutaneously. The amou nt of octreotide administered ranges from 300 to 600 mu g/day in 3 or 4 dai ly doses. Copyright (C) 1999 S. Karger AG, Basel.