Early nasojejunal feeding in acute pancreatitis is associated with a lower complication rate.
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.
Oláh
Attila
A
Department of Surgery, Petz Aladár Teaching Hospital, Gyor, Hungary. olah.seb@arrabonet.gyor.hu
Pardavi
Gábor
G
Belágyi
Tibor
T
Nagy
Attila
A
Issekutz
Akos
A
Mohamed
Gamal E
GE
D000208:Acute Disease; D000328:Adult; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use*; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D010195:Pancreatitis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D010288:Parenteral Nutrition / Q000379:methods; D011446:Prospective Studies; D018805:Sepsis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D012720:Severity of Illness Index; D013845:Thienamycins / Q000627:therapeutic use*
D013845:Thienamycins; D015378:Imipenem