scholarly journals Role of early enteral feeding in mild and moderate acute pancreatitis

2021 ◽  
Vol 8 (11) ◽  
pp. 3387
Author(s):  
Aswin George Roy ◽  
Haridas T. V.
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Enteral Feeding ◽  
Significant Risk ◽  
Length Of Hospital Stay ◽  
Advantages And Disadvantages ◽  
Early Enteral Feeding ◽  
Systemic Complication ◽  
Infective Complications

Background: Timing of enteral feeding in acute pancreatitis was always a matter of controversy. Increasing evidence suggests that early enteral feeding reduces systemic and local complications of pancreatitis and thereby hospital stay. Hence the study has been undertaken to determine the feasibility, advantages and disadvantages of early enteral feeding in mild and moderate acute pancreatitis. Methods: Patients admitted with symptoms and signs suggestive of mild and moderate acute pancreatitis who were started on early enteral feeding (within 48 hours of admission) were included in study. Blood investigation results are used to classify patients accordingly to mild and moderate acute pancreatitis based on Ransons’s score. Patients were followed up and categorized based on development of complications, length of hospital stay.Results: Majority of the patients who were started on early enteral feeding showed significant decrease in complications and hospital stay. Study also suggested that age is a significant risk in development of complications. Gender is not significant in the development of complications.Conclusions: There is significant decrease in rate of systemic complication, local infective and non-infective complications, length of hospital stay among acute pancreatitis patients who were started on early enteral feeding (within 48 hours).

scholarly journals Effect of early enteral feeding on recovery profile in mild acute pancreatitis

2020 ◽  
Vol 7 (6) ◽  
pp. 1969
Author(s):  
Kailash Chandran ◽  
Sam Christy Mammen
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Hospital Stay ◽  
Enteral Feeding ◽  
The Body ◽  
Advantages And Disadvantages ◽  
Duration Of Hospital Stay ◽  
Early Enteral Feeding ◽  
Abdominal Symptoms ◽  
Mild Acute Pancreatitis

Background: Acute pancreatitis is a pestilent disease with severity ranging from mild and self-limiting to a rapidly progressive illness leading to multi organ failure. Mild acute pancreatitis is inflammation of the pancreas with minimal remote organ involvement. Since the disturbance in the homeostasis is minimal, the treatment aims at supporting the native reparative processes of the body. One of the main supportive mechanisms is adequate nutritional supplementation. Gut barrier damage in the early phase of acute pancreatitis accounts for the bacterial translocation, initiation of sepsis, infected pancreatic necrosis and SIRS. Aim of the study was to determine the feasibility, advantages and disadvantages of early enteral nutrition in mild acute pancreatitis.Methods: 40 patients taken consecutively from units which start enteral feeds before 48 hours (study group) were compared against 40 patients taken consecutively from units where patients will be kept fasting for 48 hours (control group) to determine whether early enteral feeding is better in determining the recovery in terms of duration of hospital stay, reduction in abdominal symptoms and use of analgesics.Results: There was significant reduction in the duration of hospital stay (p=0.011), intensity and duration of abdominal pain, need for analgesics, and risk of oral food intolerance in the study group.Conclusions: Patients with mild acute pancreatitis can safely be started on early enteral feeds. It reduces gastro intestinal adverse effects, abdominal pain and need for analgesics and improves oral food tolerance causing shorter hospital stay. 

scholarly journals Early Risk Stratification in Acute Pancreatitis: The Role of Biochemical and Hematological Parameters

2020 ◽  
Vol 17 (3) ◽  
pp. 11-18
Author(s):  
Georgiana Cătălina Crișu ◽  
Vasile Daniel Balaban ◽  
Laura Elena Gaman ◽  
Mariana Jinga ◽  
Flavius Stefan Marin ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Acute Pancreatitis ◽  
Risk Stratification ◽  
Hospital Stay ◽  
Hematological Parameters ◽  
Length Of Hospital Stay ◽  
Systemic Complications ◽  
Early Risk ◽  
Length Of Hospitalization

AbstractAcute pancreatitis (AP) represents an inflammatory condition,-with a wide spectrum of local and systemic complications. Early stratification of severity of pancreatitis is an important step in guiding the management of the disease and improving outcomes. Throughout the years many researchers have looked at various risk stratification parameters which could be used from the admission of patients, however current available scores are cumbersome.Our aim was to evaluate the role of biochemical and hematological parameters in the early stratification of severity of AP, regarding the length of hospitalization.We conducted an observational study which included 100 patients with AP admitted to the Gastroenterology Department over a period 18 months. AP diagnosis was set according to 2013 ACG criteria. Demographic, clinical and imaging data related to the pancreatitis flare were collected from their charts. Length of hospital stay was used as surrogate marker for severity of AP. We evaluated different biochemical and hematological parameters which influenced the length of hospitalization.Several hematological parameters and ratio did not correlate with length of hospital stay in our study cohort, however there was a significant relation of hyperglycemia and alkaline phosphatase levels with hospitalization duration.Early risk stratification in AP remains difficult with routine blood work done at admission. Glycemic control and serum level of alkaline phosphatase seems to be correlated with length of hospital stay.

scholarly journals TO COMPARE EARLY ENTERAL FEED WITH EARLY PARENTERAL FEED IN PATIENTS OF ACUTE PANCREATITIS; A PROSPECTIVE RANDOMISED OBSERVATIONAL STUDY.

2019 ◽  
Vol 3 (12) ◽  
Author(s):  
Devesh Kumar Tiwari ◽  
Rajan B. Somani
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Enteral Feeding ◽  
Intestinal Barrier ◽  
Parenteral Feeding ◽  
Intestinal Barrier Function ◽  
Duration Of Hospital Stay ◽  
Early Enteral Feeding ◽  
Randomized Clinical Study ◽  
Feeding Group

Acute pancreatitis has been recognised since antiquity but the importance of pancreas and the severity of its inflammatory disorders were realized only in the middle of the 19th century. In accordance with this wide variation in clinical presentation, the treatment of acute pancreatitis requires a multidisciplinary approach. But even today with technical advances in medical and surgical fields acute pancreatitis remains a major cause of morbidity and mortality. Increasing evidence suggests that enteral feeding maintains the intestinal barrier function and prevents or reduces bacterial translocation from the gut. Our aim is to compare the effects of early enteral feeding with early parenteral feeding in acute pancreatitis in terms of occurrence of infective & non infective complications in both types of feeding groups and to assess the average duration of hospital stay and cost in both groups. This prospective randomized clinical study was carried out on patients of 50 diagnosed cases of acute pancreatitis admitted in Sir T Hospital from October 2017 to August 2019. Patients included in study were randomly divided into two group A (Enteral feeding) and group B (Parenteral feeding). After initiation of respective nutrition patients were observed for infective and non infective complication incidence, duration of hospital stay and other morbidities. Enteral feeding decrease the incidence of infective and non pancreatic complications, decreases duration of hospital stay. Patients tolerating soft diet earlier in early enteral feeding group compared to early parenteral feeding group. Cost of treatment is also less in enteral feeding. So in acute pancreatitis early enteral feeding is superior to early parenteral feeding. Keywords: Acute pancreatitis ,  Enteral , Parenteral, Feeding.

scholarly journals Early versus delayed enteral feeding in acute pancreatitis

2018 ◽  
Vol 5 (3) ◽  
pp. 942
Author(s):  
Manjunath B. D. ◽  
Abhishek G.
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Enteral Feeding ◽  
Necrotizing Pancreatitis ◽  
Length Of Hospital Stay ◽  
Feeding Tube ◽  
Clinical Findings ◽  
Early Enteral Feeding ◽  
Multiple Organs ◽  
Feeding Group

Background: Early enteral feeding through a nasoenteric feeding tube is often used in patients with acute pancreatitis, as compared to previous notion of pancreatic rest. This study aims to compare various outcomes of early and late enteral feeding in severe acute pancreatitis.Methods: This study was a randomized trial conducted at Victoria hospital, Bengaluru between July 2016 and June 2017. Patients with severe acute pancreatitis were randomized into early enteral feeding and late enteral feeding groups in the ratio of 1:1. Early enteral feeding group were started on oral feeds within 24 hours of admission. Late enteral feeding group were started on oral feeds after 72 hours of admission. Patient demographics, clinical findings, investigations, length of hospital stay, complications were assessed and compared.Results: In 124 out of 132 patients were included who met inclusion criteria. The mean age of patients was 28.6 years. There were 120 males (96.7%) and 4 females (3.2%). There were no significant differences in age, sex ratio and comorbidities between the two groups. Early enteral feeds group showed lesser number of gastrointestinal adverse effects after initiation of enteral feeds, lesser number of days taken to develop full tolerance to enteral feeds, lesser number of days of admission, lesser complications like necrotizing pancreatitis, single or multiple organs failure, lesser number of ICU admissions, requiring mechanical ventilation, including lesser mortality when compared to delayed enteral feeds group.Conclusions: Patients with severe acute pancreatitis can safely be started on early enteral feeds within 24 hours of admission.

scholarly journals SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study

Gut ◽  
2021 ◽  
pp. gutjnl-2020-323364
Author(s):  
Sanjay Pandanaboyana ◽  
John Moir ◽  
John S Leeds ◽  
Kofi Oppong ◽  
Aditya Kanwar ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Organ Failure ◽  
Collaborative Study ◽  
Length Of Hospital Stay ◽  
Secondary Outcome ◽  
Icu Admission ◽  
Local Complications ◽  
Persistent Organ Failure ◽  
Increased Risk

ObjectiveThere is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection.DesignA prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups.Results1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p<0.001), local complications (OR 2.91, p<0.001), persistent organ failure (OR 7.32, p<0.001), prolonged hospital stay (OR 1.89, p<0.001) and a higher 30-day mortality (OR 6.56, p<0.001). Adjusted analysis showed length of stay (OR 1.32, p<0.001), persistent organ failure (OR 2.77, p<0.003) and 30-day mortality (OR 2.41, p<0.04) were significantly higher in SARS-CoV-2 co-infection.ConclusionPatients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality.

P0032 VARIABLES AFFECTING LENGTH OF HOSPITAL STAY AND MORTALITY IN PATIENTS WITH ACUTE PANCREATITIS

2009 ◽  
Vol 20 ◽  
pp. S19-S20
Author(s):  
José Antonio Díaz-Peromingo ◽  
Paula María Pesqueira-Fontán ◽  
Marina Iglesias-Gallego ◽  
Sonia Molinos-Castro ◽  
Juan Saborido-Froján ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Length Of Hospital Stay

Advanced Endoscopic Tools

2021 ◽  
Author(s):  
Eleanor C. Fung
Keyword(s):  
Gastrointestinal Bleeding ◽  
Hospital Stay ◽  
Surgical Intervention ◽  
Length Of Hospital Stay ◽  
Therapeutic Endoscopy ◽  
Full Thickness ◽  
Evolution And Development ◽  
Improved Outcomes ◽  
Endoscopic Clips

AbstractThe advent and success of therapeutic endoscopy has expanded the utilization of endoscopy as an effective alternative to surgical intervention in some cases with decreased morbidity, improved outcomes, and shortened length of hospital stay. Gastrointestinal bleeding, perforations, leaks, fistulas, and strictures have become increasingly managed by endoscopy with the evolution and development of endoscopic tools for effective closure of full-thickness gastrointestinal defects, dilation, and hemostasis. This article reviews the characteristics and role of endoscopic clips, stents, dilation balloons, endoscopic knives, and suturing devices.

scholarly journals Repeat Local Treatment of Recurrent Colorectal Liver Metastases, the Role of Neoadjuvant Chemotherapy: An Amsterdam Colorectal Liver Met Registry (AmCORE) Based Study

Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 4997
Author(s):  
Madelon Dijkstra ◽  
Sanne Nieuwenhuizen ◽  
Robbert S. Puijk ◽  
Florentine E. F. Timmer ◽  
Bart Geboers ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Hospital Stay ◽  
Colorectal Liver Metastases ◽  
Local Treatment ◽  
Length Of Hospital Stay ◽  
Progression Free Survival ◽  
Free Survival ◽  
Significant Difference ◽  
Subgroup Analyses

This cohort study aimed to evaluate efficacy, safety, and survival outcomes of neoadjuvant chemotherapy (NAC) followed by repeat local treatment compared to upfront repeat local treatment of recurrent colorectal liver metastases (CRLM). A total of 152 patients with 267 tumors from the prospective Amsterdam Colorectal Liver Met Registry (AmCORE) met the inclusion criteria. Two cohorts of patients with recurrent CRLM were compared: patients who received chemotherapy prior to repeat local treatment (32 patients) versus upfront repeat local treatment (120 patients). Data from May 2002 to December 2020 were collected. Results on the primary endpoint overall survival (OS) and secondary endpoints local tumor progression-free survival (LTPFS) and distant progression-free survival (DPFS) were reviewed using the Kaplan–Meier method. Subsequently, uni- and multivariable Cox proportional hazard regression models, accounting for potential confounders, were estimated. Additionally, subgroup analyses, according to patient, initial and repeat local treatment characteristics, were conducted. Procedure-related complications and length of hospital stay were compared using chi-square test and Fisher’s exact test. The 1-, 3-, and 5-year OS from date of diagnosis of recurrent disease was 98.6%, 72.5%, and 47.7% for both cohorts combined. The crude survival analysis did not reveal a significant difference in OS between the two cohorts (p = 0.834), with 1-, 3-, and 5-year OS of 100.0%, 73.2%, and 57.5% for the NAC group and 98.2%, 72.3%, and 45.3% for the upfront repeat local treatment group, respectively. After adjusting for two confounders, comorbidities (p = 0.010) and primary tumor location (p = 0.023), the corrected HR in multivariable analysis was 0.839 (95% CI, 0.416–1.691; p = 0.624). No differences between the two cohorts were found with regards to LTPFS (HR = 0.662; 95% CI, 0.249–1.756; p = 0.407) and DPFS (HR = 0.798; 95% CI, 0.483–1.318; p = 0.378). No heterogeneous treatment effects were detected in subgroup analyses according to patient, disease, and treatment characteristics. No significant difference was found in periprocedural complications (p = 0.843) and median length of hospital stay (p = 0.600) between the two cohorts. Chemotherapy-related toxicity was reported in 46.7% of patients. Adding NAC prior to repeat local treatment did not improve OS, LTPFS, or DPFS, nor did it affect periprocedural morbidity or length of hospital stay. The results of this comparative assessment do not substantiate the routine use of NAC prior to repeat local treatment of CRLM. Because the exact role of NAC (in different subgroups) remains inconclusive, we are currently designing a phase III randomized controlled trial (RCT), COLLISION RELAPSE trial, directly comparing upfront repeat local treatment (control) to neoadjuvant systemic therapy followed by repeat local treatment (intervention).

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