[Nutritional support in severe acute pancreatitis. Controlled clinical trial]

Severe acute pancreatitis is an ailment with a higher than 60% mortality. The nutritional support is a fundamental part of the treatment in these patients with the aim of ameliorating traumatic metabolic response.

To compare total effectiveness of parenteral nutrition and enteral nutrition through jejunostomy in postoperated patients for acute pancreatitis.

A clinically controlled, longitudinal, prospective, experimental and at random survey was performed with our hospital's nutritional supportive service (which is a reference center) in a 16-month period. Patients postoperated on for severe pancreatitis were included (3 or more of Ranson's criteria), the ones who died before the first week were excluded. Group I was treated with total parenteral nutrition, and group II with enteral nutrition via jejunostomy through a silicon catheter placed at transoperative. The result variables were summed up at the beginning and every week for a 3-week period. The hipotheses were contrasted with Student's " t " test with a tail for independent samples of a 5% significance level.

Groups I and II were integrated by 12 and 10 patients respectively. Sex and ages were similar. Urine nitrogen was kept high in both groups, being group I the highest (ns). Nitrogen balance was kept close to neutrality in both groups (ns). Serum albumin levels were slightly increased in both groups (ns). The creatinine/size index showed loss of progressive muscular mass in both groups, being group II the lowest (p < 0,05). Total lymphocyte count depletion level improved from mild to normal in both groups, but being this more important in group II (p < 0,05). Global mortality was 40%.

Enteral nutrition was as effective as parenteral in these patients, having the advantage of being less expensive, easier to handle and with a lesser rate of septic complications. We consider that this must be the nutritional method of choice if there are contra indications for its use.