Prolonged bowel disuse under parenteral nutrition elevates risk of acalculous cholecystitis in patients with low-output enterocutaneous fistulas.

BACKGROUND

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.

METHODS

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.

RESULTS

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: 1.05-1.32, p = 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, p = 0.005). Longitudinal analysis showed nutritional parameters improved significantly (all p < 0.05) while liver enzymes concurrently elevated (all p < 0.05).

CONCLUSION

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.