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Early nasojejunal feeding in acute pancreatitis is associated with a lower complication rate
Attila Oláh1, Gábor Pardavi, Tibor Belágyi
1Department of Surgery, Petz Aladár Teaching Hospital, Gyor, Hungary. olah.seb@arrabonet.gyor.hu
Insights
Early jejunal feeding reduces septic complications in acute pancreatitis patients. Combining early enteral nutrition with antibiotic prophylaxis shows promise in preventing multiple organ failure and decreasing mortality.
Area of Science:
- Gastroenterology
- Surgical Critical Care
- Nutritional Support
Background:
- Acute pancreatitis poses significant risks of septic complications and mortality.
- Nutritional support is crucial in managing acute pancreatitis.
- Early intervention strategies are being explored to improve patient outcomes.
Purpose of the Study:
- To investigate the impact of early jejunal feeding on septic complications and mortality in acute pancreatitis.
- To compare parenteral nutrition with early enteral nutrition.
- To evaluate the efficacy of combining early jejunal feeding with prophylactic antibiotics.
Main Methods:
- A two-phase, prospective, controlled study involving patients with acute pancreatitis.
- Phase 1: Randomized comparison of parenteral nutrition versus early jejunal tube feeding (24-72 hours).
- Phase 2: Early jejunal feeding combined with prophylactic imipenem in cases of detected pancreatic necrosis.
Main Results:
- Septic complications were lower in the early enteral nutrition group (P=0.08).
- Combining early jejunal feeding with prophylactic imipenem significantly decreased septic complications (P=0.03).
- Trends towards decreased multiple organ failure (P=0.14) and mortality (P=0.13) were observed with the combined approach.
Conclusions:
- Early enteral nutrition, particularly jejunal feeding, appears beneficial in reducing septic complications in acute pancreatitis.
- The combination of early enteral nutrition and selective antibiotic prophylaxis may prevent multiple organ failure.
- Further research is warranted to confirm the impact on mortality.
Objective:
We investigated the effect of early jejunal feeding on septic complications and mortality rate in patients with acute pancreatitis in a two-phase, prospective, controlled study.
Methods:
In the first, randomized phase of the study, conventional parenteral nutrition was compared with early (within 24-72 h after the onset of symptoms) enteral nutrition. Of 89 patients admitted with acute pancreatitis, 48 patients were randomized into a parenteral group (Rindex 10, Infusamin S, Intralipid 10%; 30 kcal/kg) and 41 patients into an enteral group (jejunal tube feeding; Survimed OPD; 30 kcal/kg).
Results:
The rate of septic complications (infected pancreatic necrosis, abscess) was lower in the enteral group (P = 0.08, chi(2) test). In the second phase of the study, early jejunal feeding was combined with prophylactic imipenem (Tienam, 500 mg intravenously twice each day) when necrosis of the pancreas was detected by abdominal computed tomography. When the outcomes of 92 patients in the third group were compared with those of patients in the parenteral group, the rate of septic complications decreased significantly (P = 0.03). Multiple organ failure (P = 0.14) and mortality (P = 0.13) tended to decrease.
Conclusions:
We believe that the combination of early enteral nutrition and selective, adequate antibiotic prophylaxis may prevent multiple organ failure in patients with acute pancreatitis.