Jejunal feeding in chronic pancreatitis with severe necrosis.
BACKGROUND
Necrotizing pancreatitis is the most serious form of pancreatic inflammatory disease leading to multiorgan failure and a high (15-20%) mortality rate. The poor nutritional and metabolic conditions and secondary bacterial translocation raise the mortality rate even more.


OBJECTIVE
The aim of the study was to evaluate the effect of jejunal feeding in cases of chronic pancreatitis with extended necrosis.


METHODS
In our institution, over a five-year period, 86 patients with severe necrotizing pancreatitis were treated for extended necrosis. In 19 patients, chronic calcifying pancreatitis was demonstrated by computed tomography showing more than 20% necrosis in the residual pancreas as well.


METHODS
In 12 cases, nutrition was provided by jejunal feeding using an endoscopically placed nasojejunal feeding tube, whereas in 7 cases, hypocaloric parenteral nutrition was used.


METHODS
Retrospective unicenter study.


METHODS
The rate of healing with conservative treatment.


RESULTS
Two of the 12 jejunally fed patients were operated on because of complications of pancreatitis. Five patients required intervention in the hypocaloric parenteral nutrition group: 4 were operated on and one more needed endoscopic intervention. The healing rate was significantly higher (P=0.045) in the jejunal feeding group (83.3%) than in the parenteral nutrition (28.6%) patients.


CONCLUSIONS
In cases of chronic calcifying pancreatitis serious necrosis can develop in the residual pancreas resulting in a severe acute pancreatitis-like disease. A better healing rate was achieved and less interventions became necessary using nasojejunal tube feeding than in the parenteral nutrition group and this was analogous to what was observed in severe necrotizing pancreatitis This form of pancreatitis has not yet been described in the literature in detail. The authors suggest that it be regarded as a separate entity.
Hamvas
J
J
MAV Hospital, Budapest, Hungary. jhamvas@matavnet.hu
Schwab
R
R
Pap
A
A
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004724:Endoscopy / Q000379:methods; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods; D007583:Jejunum; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009336:Necrosis; D010195:Pancreatitis / Q000453:epidemiology / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D010288:Parenteral Nutrition / Q000379:methods; D012189:Retrospective Studies