A randomized controlled trial of enteral versus parenteral feeding in patients with predicted severe acute pancreatitis shows a significant reduction in mortality and in infected pancreatic complications with total enteral nutrition.
BACKGROUND
Infectious complications are the main cause of late death in patients with acute pancreatitis. Routine prophylactic antibiotic use following a severe attack has been proposed but remains controversial. On the other hand, nutritional support has recently yielded promising clinical results. The aim of study was to compare enteral vs. parenteral feeding for prevention of infectious complications in patients with predicted severe acute pancreatitis.


METHODS
We screened 466 consecutive patients with acute pancreatitis. A total of 70 patients with objectively graded severe acute pancreatitis were randomly allocated to receive either total enteral nutrition (TEN) or total parenteral nutrition (TPN), within 72 h of onset of symptoms. Baseline characteristics were well matched in the two groups.


RESULTS
The incidence of pancreatic infectious complications (infected pancreatic necrosis, pancreatic abscess) was significantly lower in the enterally fed group (7 vs. 16, p = 0.02). In the TEN group, 7 patients developed multiple organ failure whereas 17 parenterally fed patients developed multiple organ failure (p = 0.02). Overall mortality was 20% with two deaths in the TEN group and twelve in the TPN group (p < 0.01).


CONCLUSIONS
Early TEN could be used as prophylactic therapy for infected pancreatic necrosis since it significantly decreased the incidence of pancreatic infectious complications as well as the frequency of multiple organ failure and mortality.
Petrov
Maxim S
MS
Department of Surgery, Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russia. max.petrov@gmail.com
Kukosh
Mikhail V
MV
Emelyanov
Nikolay V
NV
D018806:APACHE; D000038:Abscess / Q000209:etiology; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002097:C-Reactive Protein / Q000378:metabolism; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010195:Pancreatitis / Q000150:complications* / Q000628:therapy*; D010288:Parenteral Nutrition; D011379:Prognosis; D016896:Treatment Outcome
D002097:C-Reactive Protein