In the case of proximal enterocutaneous fistulae (e.g., esophageal, gastric, duodenal, proximal jejunum), distal jejunal feeds are always preferable to parenteral nutrition and should be the mainstay of therapy. The nutritional requirements for patients with enterocutaneous fistula may be excessive because of the significant gastrointestinal (GI) protein losses and catabolism associated with these conditions. It may be prudent to maintain the patient on parenteral nutrition until enteral feeds are advanced and optimized. Optimal caloric support is frequently not possible for 4 to 5 days following initiation of enteral feeds, and parenteral nutrition can bridge that gap in critically ill patients. In the case of a more proximal fistula, it is often possible to cannulate the distal limb of the fistula itself to feed the distal small bowel. Such procedures often require expert interventional radiologists and should not be performed without the guidance of an experienced GI surgeon.