Early oral feeding in acute pancreatitis: an alternative approach to tube feeding. Preliminary report.
BACKGROUND
Jejunal feeding is accepted in the treatment of severe acute pancreatitis (AP). Early oral feeding (EOF) is deemed to be detrimental in the early phase of AP. The aim of this study was to assess the safety and effectiveness of EOF in the treatment of AP.


METHODS
29 AP patients were prospectively enrolled within 1.96 days from the onset of disease. APACHE II score, SIRS, MODS, serum CRP and lipase were evaluated. All patients received EOF when gastro-enteric transit was not severely impaired. ICU, hospital stay and main outcomes were assessed.


RESULTS
APACHE II score was > or = 8 in 10 patients at the admission ranging 0-13 points for the whole group. Alcohol (62%) and gallstones (38%) were the main etiologic factors. SIRS and MODS were diagnosed in 65% and pleural effusion in 24% of patients. EOF was started on average 3.27 days after admission providing 571 ml (280.0-1115.0 ml) of enteral formula daily for 10.38 days. Median lipase activity was 690 U/l (90-10175 U/l) and CRP concentration reached 91.25 mg/dL (3.5-210 mg/dL) before EOF. Progressive decrease of lipase activity and CRP concentration was observed during the EOF course, reaching median CRP 18.6 mg/L (4.6-96.7mg/L) by discharge. Two patients underwent surgical intervention. Minor side effects of EOF were successfully managed in 4 patients. No mortality was observed.


CONCLUSIONS
EOF could be a safe and effective alternative of nutritional support in AP patients when gastro-enteric transit is not severely impaired. For better EOF assessment further clinical trials are required.
Pupelis
G
G
Clinical Hospital "Gailezers", Department of Surgery, Riga, Latvia. pupelis@gailes.lv
Snippe
K
K
Plaudis
H
H
Rudakovska
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D004750:Enteral Nutrition / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008049:Lipase / Q000097:blood; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000628:therapy*; D019283:Pancreatitis, Acute Necrotizing / Q000628:therapy; D011446:Prospective Studies; D012449:Safety; D013997:Time Factors
D002097:C-Reactive Protein; D008049:Lipase