Home parenteral nutrition: an alternative approach to the management of complicated gastrointestinal fistulas not responding to conventional medical or surgical therapy.

Twelve patients, 9 with enterocutaneous fistulas and 3 with enterovaginal fistulas, were placed on a home parenteral nutrition (HPN) program after conventional inpatient total parenteral nutrition with bowel rest and/or surgical attempts at fistula closure failed. Fistula closure was achieved (in 66%) after from 28 to 400 days on the program. Six closed spontaneously while 2 were closed surgically. Underlying inflammation in the bowel and the persistence of fistula drainage beyond 180 days were indicative of poor prognosis for closure. Number, location, and volume of drainage were not useful prognostic indices. HPN offers an alternative approach in the management of "intractable" gastrointestinal fistulas.