Nasogastric versus nasojejunal tube feeding for severe acute pancreatitis

Acute pancreatitis is a sudden inflammatory disease that could be developed into a fatal condition. Traditional dogma was to rest the pancreas by fasting. However, evidence shows the benefits of early enteral feeding resulting in a shorter hospital stay, improved mortality, multi-organ failure, systemic infections, and the need for operative interventions. Clinicians should encourage enteral feeding as soon as possible even in severe acute pancreatitis if there are no contraindications. An immediate solid diet could be attempted. Regarding tube feeding, the nasojejunal tube did not show superiority to the nasogastric tube. Different formulas and probiotics need more investigation. Guidelines are against using prophylactic antibiotics, but Korean centers still report overuse of antibiotics. However, there is still a debate about using prophylactic antibiotics in severe acute pancreatitis. Broad-spectrum antibiotics should be initiated when an infection is suspected. In conclusion, enteral nutritional support and optimal use of antibiotics are the keys to the management of acute pancreatitis.

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Early versus On-Demand Nasoenteric Tube Feeding in Acute Pancreatitis

50 Studies Every Intensivist Should Know ◽

10.1093/med/9780190467654.003.0034 ◽

2018 ◽

pp. 204-208

Author(s):

Peter J. Fagenholz

Keyword(s):

Acute Pancreatitis ◽

Tube Feeding ◽

Oral Intake ◽

Adequate Nutrition ◽

On Demand ◽

Major Complications ◽

Nasojejunal Tube ◽

Poor Oral Intake ◽

Oral Diet

This study evaluated whether starting nasojejunal tube feeding within 24 hours of presentation would reduce the rate of death or major complications in patients with acute pancreatitis. This strategy was compared to allowing patients to take an “on demand” oral diet and only initiating nasojejunal tube feeding if there was poor oral intake by 96 hours after presentation. There was no difference between the two groups in any of the measured outcomes, though the study may have been underpowered. We conclude it is acceptable to allow an on-demand oral diet and reserve nasoenteric feeding for patients who have not achieved adequate nutrition by 96 hours after presentation. It is not necessary or beneficial to start nasojejunal tube feeds in the first 24 hours.

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Early nasojejunal tube feeding versus nil-by-mouth in acute pancreatitis: A randomized clinical trial

Pancreatology ◽

10.1016/j.pan.2016.04.003 ◽

2016 ◽

Vol 16 (4) ◽

pp. 523-528 ◽

Cited By ~ 20

Author(s):

D. Stimac ◽

G. Poropat ◽

G. Hauser ◽

V. Licul ◽

N. Franjic ◽

...

Keyword(s):

Clinical Trial ◽

Acute Pancreatitis ◽

Randomized Clinical Trial ◽

Tube Feeding ◽

Nasojejunal Tube

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ENTERAL NUTRITION WITH NASOGASTRIC VS NASOJEJUNAL TUBE IN SEVERE ACUTE PANCREATITIS: A PRAGMATIC STUDY

Digestive and Liver Disease ◽

10.1016/s1590-8658(09)60261-9 ◽

2009 ◽

Vol 41 ◽

pp. S101

Author(s):

M. Piciucchi ◽

E. Merola ◽

M. Marignani ◽

F. Panzuto ◽

F. Baccini ◽

...

Keyword(s):

Acute Pancreatitis ◽

Enteral Nutrition ◽

Severe Acute Pancreatitis ◽

Nasojejunal Tube ◽

Pragmatic Study

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A Pilot Study to Assess Tolerability of Early Enteral Nutrition via Esophagostomy Tube Feeding in Dogs with Severe Acute Pancreatitis

Journal of Veterinary Internal Medicine ◽

10.1111/j.1939-1676.2011.0703.x ◽

2011 ◽

Vol 25 (3) ◽

pp. 419-425 ◽

Cited By ~ 31

Author(s):

C.S. Mansfield ◽

F.E. James ◽

J.M. Steiner ◽

J.S. Suchodolski ◽

I.D. Robertson ◽

...

Keyword(s):

Acute Pancreatitis ◽

Pilot Study ◽

Enteral Nutrition ◽

Severe Acute Pancreatitis ◽

Tube Feeding ◽

Early Enteral Nutrition

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Comparison of complications attributable to enteral and parenteral nutrition in predicted severe acute pancreatitis: a systematic review and meta-analysis

British Journal Of Nutrition ◽

10.1017/s0007114510000887 ◽

2010 ◽

Vol 103 (9) ◽

pp. 1287-1295 ◽

Cited By ~ 42

Author(s):

Maxim S. Petrov ◽

Kevin Whelan

Keyword(s):

Acute Pancreatitis ◽

Parenteral Nutrition ◽

Severe Acute Pancreatitis ◽

Meta Analysis ◽

Tube Feeding ◽

Infectious Complications ◽

Cochrane Library ◽

Randomised Controlled ◽

The Cochrane Library ◽

Complications And Mortality

Enteral nutrition (EN) reduces infectious complications and mortality compared with parenteral nutrition (PN) in patients with predicted severe acute pancreatitis. However, to date the complications attributable to the administration of EN and PN in this patient group have not been comprehensively studied. The aim of the study was to systematically review the complications related to the use of nutrition in patients with predicted severe acute pancreatitis receiving EN v. PN. The Cochrane Library, MEDLINE and Scopus were searched. Randomised controlled trials (RCT) of EN v. PN in predicted severe acute pancreatitis were selected. Pooled estimates of complications were expressed as OR with corresponding 95 % CI. Data from five RCT were meta-analysed. Diarrhoea occurred in six of ninety-two (7 %) patients receiving PN and twenty-four of eighty-two (29 %) patients receiving EN (OR 0·20; 95 % CI 0·09, 0·43; P < 0·001). Hyperglycaemia developed in twenty-one of ninety-two (23 %) patients receiving PN and nine of eighty-two (11 %) receiving EN (OR 2·59; 95 % CI 1·13, 5·94; P = 0·03). Given a significant reduction in infectious complications and mortality associated with the use of EN over PN that has been consistently demonstrated in previous studies, the former should be the treatment of choice in acute pancreatitis. Further clinical studies should investigate the strategies to mitigate the complications of enteral tube feeding in patients with acute pancreatitis.

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Nutritional Support in Patients with Severe Acute Pancreatitis-Current Standards

Nutrients ◽

10.3390/nu13051498 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1498

Author(s):

Beata Jabłońska ◽

Sławomir Mrowiec

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Infectious Complications ◽

Nutritional Risk ◽

Gastrointestinal Dysmotility ◽

Gut Barrier Function ◽

Nasojejunal Tube ◽

Nutritional Disturbances ◽

Current Standards

Severe acute pancreatitis (SAP) leads to numerous inflammatory and nutritional disturbances. All SAP patients are at a high nutritional risk. It has been proven that proper nutrition significantly reduces mortality rate and the incidence of the infectious complications in SAP patients. According to the literature, early (started within 24–48 h) enteral nutrition (EN) is optimal in most patients. EN protects gut barrier function because it decreases gastrointestinal dysmotility secondary to pancreatic inflammation. Currently, the role of parenteral nutrition (PN) in SAP patients is limited to patients in whom EN is not possible or contraindicated. Early versus delayed EN, nasogastric versus nasojejunal tube for EN, EN versus PN in SAP patients and the role of immunonutrition (IN) in SAP patients are discussed in this review.

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P-P14 A multi-centre retrospective cohort study exploring weight loss and nutritional interventions in severe acute pancreatitis

British Journal of Surgery ◽

10.1093/bjs/znab430.237 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

David Bourne ◽

Neil Bibby ◽

Emily Button ◽

Tara Kenny ◽

Marie Labaquere ◽

...

Keyword(s):

Weight Loss ◽

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Nutritional Support ◽

Tube Feeding ◽

Exclusion Criterion ◽

Inclusion Criteria ◽

Nutritional Interventions ◽

Number Of Patients ◽

Patients With Diabetes

Abstract Background Acute pancreatitis is among the most common acute gastrointestinal diseases. Severe acute pancreatitis (SAP) develops in up to 20% of patients and is associated with increased morbidity and mortality. Patients may have long and complex hospital admissions; nutritional support is a cornerstone of management. Due to increased metabolic demands and development of pancreatic exocrine insufficiency (PEI) patients frequently endure excessive weight loss. There has been little research into the effect of SAP on nutritional status and necessary nutritional interventions. This project aimed to characterise weight loss in SAP, routes of feeding, and PEI - including pancreatic enzyme replacement therapy (PERT). Methods Participating centres were recruited via the Nutrition Interest group of PSGBI and were required to retrospectively recruit 5-10 consecutive patients admitted following January 1st 2018 using a predefined data collection tool. Inclusion criteria included; age ≥18 years and diagnosed SAP of any aetiology (defined by organ failure of > 48hrs). The exclusion criterion was where death occurred during hospital admission. Data were collected regarding, weight changes, anthropometric measures, nutritional interventions used, PERT administration and diabetic status, including insulin use. All analyses were performed with IBM SPSS 22 (IBM Corp. Armonk, NY), with p < 0.05 considered statistically significant. Results 34 patients (22 male) from five centres met the inclusion criteria and were included in data analysis. Most common aetiologies were gallstones (13/34) and alcohol (11/34). A mean weight reduction of 12.6% (SD ± 10.77) (p < 0.001) was observed. Multivariate analyses showed that higher premorbid weight (p = 0.02) and PERT administration with tube feeding (p = 0.005) were associated with weight loss. Most patients (29/34) received tube feeding; mean duration 56.8 (SD ± 58.29) days. There was a significant increase in patients with diabetes requiring insulin therapy from admission (n = 3) to discharge (n = 9) (p = 0.03). Most (29/31) patients required oral PERT prescription on discharge. Conclusions Patients with SAP lost significant weight during the course of their illness despite aggressive, extended nutritional support and the correction of PEI with PERT. The significant increase in insulin dependence among patients with diabetes, and the number of patients requiring PERT on discharge, reflects the destructive effect SAP has on pancreatic function. These multicentre findings could be used as a baseline for determining effectiveness of nutritional interventions in SAP and may provide a basis for further prospective research in this area.

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