{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T05:36:31Z","timestamp":1782970591610,"version":"3.54.5"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prolonged bowel rest during parenteral nutrition (PN) for low-output enterocutaneous fistulas (ECF) may induce acalculous cholecystitis (AAC). We evaluated the relationship between bowel disuse duration and AAC risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included 92 patients with low-output ECF managed with a standardized PN strategy. AAC diagnosis was based on CT criteria. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were used to assess risk factors and determine predictive thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The incidence of AAC was 45.7% (42\/92). In adjusted analysis, each day of bowel disuse increased AAC risk by 18% (aOR = 1.18, 95% CI: 1.05\u20131.32,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.012). ROC analysis identified 48 days as the optimal cutoff (AUC = 0.68, sensitivity 66.7%, specificity 74%). Predictive accuracy improved substantially when combined with admission GGT (AUC = 0.924). Spontaneous fistula closure occurred in 65.2% of patients (60\/92), with lower post-somatostatin output predicting higher closure likelihood (aHR = 0.99 per mL\/day,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.005). Longitudinal analysis showed nutritional parameters improved significantly (all\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05) while liver enzymes concurrently elevated (all\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Prolonged bowel disuse during PN for ECF was associated with an increased incidence of AAC, with 48 days identified as a potential monitoring threshold. The addition of admission GGT enhanced predictive performance, highlighting the need for individualized risk assessment when balancing fistula closure goals against hepatobiliary complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1809537","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T04:24:10Z","timestamp":1782966250000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prolonged bowel disuse under parenteral nutrition elevates risk of acalculous cholecystitis in patients with low-output enterocutaneous fistulas"],"prefix":"10.3389","volume":"13","author":[{"given":"Tingting","family":"Shao","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Jiangning Hospital, Nanjing","place":["Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risheng","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Jiangning Hospital, Nanjing","place":["Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Jiangning Hospital, Nanjing","place":["Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Jiangning Hospital, Nanjing","place":["Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1007\/s10151-022-02656-3","article-title":"Treatment of enterocutaneous fistula: a systematic review and meta-analysis.","volume":"26","author":"Gefen","year":"2022","journal-title":"Tech Coloproctol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"2046","DOI":"10.1097\/JS9.0000000000002191","article-title":"Nomogram for predicting severe abdominal adhesions prior to definitive surgery in patients with anastomotic fistula post-small intestine resection: a cohort study.","volume":"111","author":"Yao","year":"2025","journal-title":"Int J Surg."},{"key":"B3","doi-asserted-by":"publisher","first-page":"93","DOI":"10.31729\/jnma.5780","article-title":"Management of enterocutaneous fistula: a review.","volume":"60","author":"Ghimire","year":"2022","journal-title":"JNMA J Nepal Med Assoc."},{"key":"B4","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1007\/s00268-007-9371-1","article-title":"Treatment strategies in 135 consecutive patients with enterocutaneous fistulas.","volume":"32","author":"Visschers","year":"2008","journal-title":"World J Surg."},{"key":"B5","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1002\/ncp.11245","article-title":"Use of parenteral nutrition in the management of enterocutaneous fistula.","volume":"40","author":"Kumpf","year":"2025","journal-title":"Nutr Clin Pract."},{"key":"B6","doi-asserted-by":"publisher","first-page":"5073","DOI":"10.3748\/wjg.14.5073","article-title":"Treatment of upper gastrointestinal fistula and leakage with personal stage nutrition support.","volume":"14","author":"Wang","year":"2008","journal-title":"World J Gastroenterol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1097\/SLA.0b013e318260aa26","article-title":"A meta-analysis of outcomes following use of somatostatin and its analogues for the management of enterocutaneous fistulas.","volume":"256","author":"Rahbour","year":"2012","journal-title":"Ann Surg."},{"key":"B8","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1097\/MEG.0b013e32834a345d","article-title":"Systematic review and meta-analysis of the role of somatostatin and its analogues in the treatment of enterocutaneous fistula.","volume":"23","author":"Stevens","year":"2011","journal-title":"Eur J Gastroenterol Hepatol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1177\/0148607116680792","article-title":"ASPEN-FELANPE clinical guidelines.","volume":"41","author":"Kumpf","year":"2017","journal-title":"JPEN J Parenter Enteral Nutr."},{"key":"B10","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1159\/000520025","article-title":"Advances in the study of acute acalculous cholecystitis: a comprehensive review.","volume":"40","author":"Fu","year":"2022","journal-title":"Dig Dis."},{"key":"B11","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1016\/j.gtc.2010.02.012","article-title":"Acute acalculous cholecystitis.","volume":"39","author":"Barie","year":"2010","journal-title":"Gastroenterol Clin North Am."},{"key":"B12","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1002\/jhbp.515","article-title":"Tokyo guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos).","volume":"25","author":"Yokoe","year":"2018","journal-title":"J Hepatobiliary Pancreat Sci."},{"key":"B13","first-page":"699","article-title":"Alimentations \u00e9l\u00e9mentaire, semi-\u00e9l\u00e9mentaire, polym\u00e9rique. Choix, indications, utilisation raisonn\u00e9e [Elemental, semi-elemental, polymeric diets. Choice, indications, rational use].","volume":"41","author":"Cosnes","year":"1991","journal-title":"Rev Prat."},{"key":"B14","doi-asserted-by":"publisher","first-page":"721402","DOI":"10.3389\/fmed.2021.721402","article-title":"Compared with a nasointestinal route, pre-operative enteral nutritionviaa nasogastric tube reduced the incidence of acalculous acute cholecystitis after definitive surgery for small intestinal fistula.","volume":"8","author":"Yao","year":"2021","journal-title":"Front Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1089\/sur.2019.297","article-title":"Acute acalculous cholecystitis-associated bacteremia has worse outcome.","volume":"22","author":"Rincon","year":"2021","journal-title":"Surg Infect."},{"key":"B16","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.cgh.2009.08.034","article-title":"Acute acalculous cholecystitis: a review.","volume":"8","author":"Huffman","year":"2010","journal-title":"Clin Gastroenterol Hepatol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1514","DOI":"10.1001\/jama.2022.2969","article-title":"Acute cholecystitis.","volume":"327","author":"Walter","year":"2022","journal-title":"JAMA."},{"key":"B18","doi-asserted-by":"publisher","first-page":"4870","DOI":"10.3748\/wjg.v24.i43.4870","article-title":"Acute acalculous cholecystitis in children.","volume":"24","author":"Poddighe","year":"2018","journal-title":"World J Gastroenterol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1631484","DOI":"10.3389\/fnut.2025.1631484","article-title":"Nutritional and inflammatory biomarkers in predicting spontaneous anastomotic leakage closure following enterocutaneous fistula resection: the role of postoperative CRP-lymphocyte ratio.","volume":"12","author":"Yu","year":"2025","journal-title":"Front Nutr."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1016\/j.bpg.2006.03.008","article-title":"Gallstone disease: primary and secondary prevention.","volume":"20","author":"Venneman","year":"2006","journal-title":"Best Pract Res Clin Gastroenterol."}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1809537\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T04:24:11Z","timestamp":1782966251000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1809537\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":20,"alternative-id":["10.3389\/fnut.2026.1809537"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1809537","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,2]]},"article-number":"1809537"}}