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RecruitingNCT03469609MUC-FIREUpdated Aug 17, 2026

Mucous Fistula Refeeding Reduces the Time From Enterostomy Closure to Full Enteral Feeds ("MUC-FIRE" Trial)

An interventional study of mucous fistula refeeding in Enterostomy, sponsored by University of Leipzig. Recruiting at 17 sites in 3 countries. Open to participants aged Up to 12 Months. Per ClinicalTrials.gov, last updated 2026-08-17.

Sponsored by University of Leipzig · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
120
Allocation
Randomized
Ages
Up to 12 Months
Sex
All
01

Study summary

The primary objective of this study is to demonstrate that mucous fistula refeeding between enterostomy creation and enterostomy closure reduces the time to full enteral feeds after enterostomy closure compared to standard of care.

Read the detailed description

Enterostomies in children may be created for different reasons. During the presence of an enterostomy the regular stool transfer is interrupted as the distal part of the bowel (the part following the enterostomy) does not participate in the circulation of stool. Therefore it does not contribute to the resorption of enteral contents. As a consequence these children need additional parenteral nutrition. Due to the negative side-effects of parenteral nutrition all patients should return to enteral nutrition as soon as possible. Consequently, many pediatric surgical centers worldwide routinely perform mucous fistula refeeding (MFR) into the former unused bowel after enterostomy creation because case reports and retrospective analyses show low complication rates and faster postoperative weight gain. Several providers, however, shy away from this approach because to date there is still no high quality evidence for the benefit of this Treatment.The aim of this study is to assess the effects of mucous fistula refeeding in a randomized, prospective trial. We hypothesize that MFR between enterostomy creation and enterostomy closure reduces the time to full enteral feeds after enterostomy closure compared to the group without refilling. Moreover, the side effects of parenteral nutrition may be reduced and the postoperative hospital care of infants undergoing ostomy closure shortened.

02

Conditions studied

  • Enterostomy

Keywords

  • infants
  • necrotizing enterocolitis (NEC)
  • focal intestinal perforation (FIP)
  • enterostomy creation
  • bowel reanastomosis
  • enteral feeding
  • caloric intake
  • parenteral nutrition
  • complication rate
  • reduction of hospital expenses
  • length of hospital stay
  • refeeding
03

Who can participate

Ages eligible
Up to 12 Months
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  1. Infants \< 366 days,
  2. Ileostomy / Jejunostomy,
  3. double loop enterostomies and split enterostomies (with mucous fistula)
  4. Signed written informed consent obtained by parents/legal guardians and willingness of parents/legal guardians to comply with treatment and follow-up procedures of their child

Exclusion criteria

Exclusion Criteria:

  1. resection of ileocecal valve,
  2. colostomy,
  3. small bowel atresia,
  4. multiple ostomies (more than just an enterostomy and a mucous fistula),
  5. chromosomal abnormalities (if known at the time of randomization),
  6. Hirschsprung's disease,
  7. participation in another drug-intervention study
  8. Intestinal perforation due to a hemodynamic heart defect
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
120 participants (estimated)

Study arms

  • Experimental
    Perioperative mucous fistula refeeding

    Perioperative mucous fistula refeeding between enterostomy creation and enterostomy closure

    Other: mucous fistula refeeding

  • No intervention
    No mucous fistula refeeding

    No perioperative mucous fistula refeeding

Interventions

  • Othermucous fistula refeeding

    Transfer of infants' own stool

05

What researchers measure

Primary outcomes

  1. Time to full enteral feeds (hours)

    Time to full feeds (hours), defined as time to actual enteral intake of the age-dependent caloric requirements per day (defined as 90 or 120kcal/kg/24h) for at least 24 hours and a concomitant reduction of parenteral fluids to \<20ml/kg/24h. 1. The nutrition aim is 120 kcal/kg/24h for premature infants with a birth weight \< 1000g or premature infants with a birth weight ≥ 1000g and mother's gestation week at birth before 37+0. 2. The nutrition aim is 90 kcal/kg/24h for born mature infants, mother's gestation week at birth at least 37+0.

    Time frame: week 4 to week 12 daily

Secondary outcomes

  1. Time to first bowel movement

    Cleaning and changing of infants diapers will be performed according to a fixed schedule in order to uniformly document the time to first bowel movement

    Time frame: Week 4 to week 12 daily

  2. Thriving

    Measurement of body weight

    Time frame: Week 1 to week 12 daily; follow-up (month 3, 6, 12)

  3. Z-Score (standard deviation score)

    Measurement of weight \[weight for age, World Health Organization (WHO)\]

    Time frame: Week 1 to week 12 daily, follow-up (month 3, 6, 12)

  4. Number of days of postoperative total parenteral nutrition (TPN)

    Calculation of days of postoperative TPN starts on the day of operation and ends on the day of full enteral nutrition

    Time frame: Week 2 to week 12 daily, follow-up (month 3, 6, 12)

  5. Laboratory parameter indicating cholestasis

    Measurement of conjugated Bilirubin (µmol/l)

    Time frame: Week 1 to week 12 daily, follow-up (month 3)

  6. Assessment of adverse events (AEs)

    Adverse events will be collected by the investigator either based on the information provided spontaneously by the parents of patient or evaluated by non-suggestive questions.

    Time frame: Week 1 to week 12 daily, follow-up (month 3, 6, 12)

  7. Assessment of serious adverse events (SAEs)

    Adverse events will be collected by the investigator either based on the information provided spontaneously by the parents of patient or evaluated by non-suggestive questions.

    Time frame: Week 1 to week 12 daily, follow-up (month 3, 6, 12)

  8. Postoperative weight gain (g/d)

    Weight gain during the subsequent 5 days after reaching the primary endpoint following enterostomy closure

    Time frame: week 4 to week 12

  9. Central venous line (CVL)

    duration (days) and number of CVL infections (definition of infection: Neo-Kiss Guidelines)

    Time frame: Week 1 to week 12

  10. hospitalisation

    Length of hospital stay (days)

    Time frame: week 1 to week 12

  11. jump in caliber

    Estimated ratio of the diameter of the two bowel loops which are anastomosed.

    Time frame: week 5

  12. Sodium resorption

    Sodium in Urine (mmol/l)

    Time frame: Week 1 to week 12 daily, follow-up (month 3)

  13. Status of liver enzymes

    Gamma-Glutamyltransferase (GGT) , Alanine-Aminotransferase (ALT) , Aspartate-Aminotransferase (AST) (µkat/l)

    Time frame: Week 1 to week 12 daily, follow-up (month 3)

  14. Laboratory parameters

    Haemoglobin (g/dl)

    Time frame: Week 1 to week 12 daily, follow-up (month 3)

  15. Time to full volume intake per day (in hours)

    Time to full age-dependent volume intake per day (defined as 150ml/kg/24h for premature infants and 120ml/kg/24h for mature born infants as well as corrected mature infants) (in hours). 1. The volume aim is 150 ml/kg/24h for premature infants with a birth weight \< 1000g or premature infants with a birth weight ≥ 1000g and mother's gestation week at birth before 37+0. 2. The volume aim is 120 ml/kg/24h for born mature infants, mother's gestation week at birth at least 37+0.

    Time frame: week 4 to week 12 daily

06

Study locations

13 of 17 sites recruiting
  • Universitätsklinik für Kinder- und Jugendchirurgie
    Graz, 8036, Austria
    • Holger Till, Univ. Prof. · Contact
    Recruiting
  • Universitätsklinik für Kinder- und Jugendheilkunde
    Vienna, 1090, Austria
    • Christoph Binder, Dr. · Contact
    Recruiting
  • Universitätsklinik für Kinder- und Jugendmedizin Tübingen
    Tübingen, Baden-Wurttemberg 72076, Germany
    • Christian Poets, Prof. Dr. · Contact
    Recruiting
  • Städtisches Klinikum München GmbH/ Klinikum Schwabing
    München, Bavaria 80804, Germany
    • Stuart Hosie, Prof. Dr. · Contact
    Recruiting
  • Zentrum der Chirurgie, Klinik für Kinderchirurgie
    Frankfurt am Main, Hesse 60590, Germany
    Terminated
  • Auf der Bult, Kinder- und Jugendkrankenhaus, Kinderchirurgie und Kinderurologie
    Hanover, Lower Saxony 30173, Germany
    • Barbara Ludwikowski, PD Dr. · Contact
    Recruiting
  • Hannover Medical School, Clinic for Pediatric Surgery
    Hanover, Lower Saxony 30625, Germany
    • Julia Brendel, PD Dr. med. · Contact
    Recruiting
  • Marien Hospital Witten, Ruhr-University Bochum, Department of Pediatric Surgery
    Witten, North Rhine-Westphalia 58452, Germany
    • Jochen Hubertus, Prof. Dr. · Contact
    Recruiting
  • Universitätsmedizin Mainz, Klinik und Poliklinik für Kinderchirurgie
    Mainz, Rhineland-Palatinate 55131, Germany
    Withdrawn
  • Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Kinderchirurgie
    Dresden, Saxony 01304, Germany
    Terminated
  • University of Leipzig
    Leipzig, Saxony 04103, Germany
    Recruiting
  • University Hospital Augsburg, Clinic for Pediatric Surgery
    Augsburg, 86156, Germany
    • Tobias Schuster, Dr. med. · Contact
    Recruiting
  • Hamburg [University Hospital Hamburg Eppendorf/UKE & Altonaer Kinderkrankenhaus/AKK]
    Hamburg, 20246, Germany
    • Konrad Reinshagen, Prof. Dr. · Contact
    Not yet recruiting
  • University Hospital Marburg, Clinic for Pediatric Surgery
    Marburg, 35043, Germany
    • Guido Seitz, Prof. Dr. · Contact
    Recruiting
  • Munich Clinic Harlaching
    München, 81545, Germany
    • Marcus Krüger, Prof. Dr. med. · Contact
    Recruiting
  • Amsterdam University Medical Centers
    Amsterdam, 1000 GG, Netherlands
    • Ernest van Heurn, Prof. Dr. · Contact
    Recruiting
  • Erasmus University Medical Center Rotterdam
    Rotterdam, 3015 CE, Netherlands
    • H.R. (Hester) Langeveld-Benders, Dr. · Contact
    Recruiting
07

References and documents

Publications

  • Grosshennig A, Wiesner S, Hellfritsch J, Thome U, Knupfer M, Peter C, Metzelder M, Binder C, Wanz U, Flucher C, Brands BO, Mollweide A, Ludwikowski B, Koluch A, Scherer S, Gille C, Theilen TM, Rochwalsky U, Karpinski C, Schulze A, Schuster T, Weber F, Seitz G, Gesche J, Nissen M, Jager M, Koch A, Ure B, Madadi-Sanjani O, Lacher M. MUC-FIRE: Study protocol for a randomized multicenter open-label controlled trial to show that MUCous FIstula REfeeding reduces the time from enterostomy closure to full enteral feeds. Contemp Clin Trials Commun. 2023 Feb 20;32:101096. doi: 10.1016/j.conctc.2023.101096. eCollection 2023 Apr. PubMed 36875554 ↗

Study documents

  • Protocol and statistical analysis plan · Apr 20, 2026

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No

08

Registry details

Key details

Study ID
NCT03469609
Lead sponsor
University of Leipzig
Collaborators
German Research Foundation, Hannover Medical School
Responsible party
Martin Lacher (Prof. Dr. med., University of Leipzig) — Principal investigator
First posted
Mar 19, 2018
Start date
Jun 18, 2018
Primary completion
Dec 2027 (estimated)
Completion
Dec 2027 (estimated)
Last update
Aug 17, 2026

Study contacts

Martin Lacher, Prof. Dr. med.
Contact
muc-fire-leipzig@medizin.uni-leipzig.de
+49-341-97 ext. 26400
Omid Madadi-Sanjani, PD Dr. med.
Contact
O.Madadi-Sanjani@uke.de
+49-176 ext. 20192676
Omid Madadi-Sanjani, PD Dr. med.
principal investigator · University Medical Center Hamburg-Eppendorf (UKE), Department of Pediatric Surgery
Martin Lacher, Prof. Dr. med.
principal investigator · University of Leipzig, Department of Pediatric Surgery

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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