Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial.
BACKGROUND
Parenteral nutrition is well established for providing nutritional support in acute pancreatitis while avoiding pancreatic stimulation. However, it is associated with complications and high cost. Benefits of enteral feeding in other disease states prompted a comparison of early enteral feeding with total parenteral nutrition in this clinical setting.


METHODS
Thirty-eight patients with acute severe pancreatitis were randomized into two groups. The first (n = 18) received enteral nutrition through a nasoenteric tube with a semi-elemental diet, while the second group (n = 20) received parenteral nutrition through a central venous catheter. Safety was assessed by clinical course of disease, laboratory findings and incidence of complications. Efficacy was determined by nitrogen balance. The cost of nutritional support was calculated.


RESULTS
Enteral feeding was well tolerated without adverse effects on the course of the disease. Patients who received enteral feeding experienced fewer total complications (P < 0.05) and were at lower risk of developing septic complications (P < 0.01) than those receiving parenteral nutrition. The cost of nutritional support was three times higher in patients who received parenteral nutrition.


CONCLUSIONS
This study suggests that early enteral nutrition should be used preferentially in patients with severe acute pancreatitis.
Kalfarentzos
F
F
Department of Surgery, University of Patras, Greece.
Kehagias
J
J
Mead
N
N
Kokkinis
K
K
Gogos
C A
CA
D000208:Acute Disease; D000328:Adult; D000368:Aged; D004750:Enteral Nutrition / Q000009:adverse effects / Q000191:economics; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications / Q000191:economics / Q000628:therapy*; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000191:economics; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome