Enteral nutrition in severe acute pancreatitis.
BACKGROUND
There is controversy concerning the merits of enteral and parenteral nutrition in the management of patients with severe acute pancreatitis.


OBJECTIVE
This study was undertaken to evaluate the effect of enteral nutrition versus parenteral nutrition on serum markers of inflammation and outcome in patients with severe acute pancreatitis.


METHODS
Tertiary care centre in North India.


METHODS
A prospective clinical trial.


METHODS
Fifty consecutive patients with severe acute pancreatitis were randomized in a prospective trial to receive total enteral nutrition (n=25) or total parenteral nutrition (n=25). Enteral nutrition was delivered distal to the ligament of Treitz. Serum C-reactive protein, transferrin levels, albumin, surgical intervention, infections, duration of hospital stay and mortality were compared in the two groups.


RESULTS
The mean age in the enteral nutrition group was 38.4+/-13.8 years and in the total parenteral nutrition group 41.1+/-11.3 years. The etiological factors were alcohol (n=19), gallstones (n=23), idiopathic (n=7) and drug-induced (n=1). There was a significant decrease in serum C-reactive protein values in both the enteral nutrition group and the total parenteral nutrition group at one week and two weeks (P<0.001 for both). Serum albumin rose from a prenutritional value of 2.82+/-0.51 g/dL to 3.34+/-0.45 g/dL on day 14 of nutritional support in the enteral nutrition group (P=0.003); in the total parenteral nutrition group, the level rose from 3.10+/-0.59 g/dL to 3.21+/-0.30 g/dL (P=0.638). A significant rise in transferrin value was observed from day 0 to day 14 in enteral nutrition group (169+/-30 to 196+/-36 mg/dL; P<0.001) whereas, in the total parenteral nutrition group, a less significant difference (191+/-41 to 201+/-29 mg/dL; P=0.044) was observed. There was no significant difference in surgical intervention (56.0% versus 60.0%; P=1.000), infective complications (64.0% versus 60.0%; P=1.000), hospital stay (42 days, 15-108 days, versus 36 days, 20-77 days; median, range; P=0.755), or mortality (20.0% versus 16.0%; P=1.000) in enteral nutrition versus total parenteral nutrition, respectively.


CONCLUSIONS
Enteral nutrition and total parenteral nutrition are comparable in the management of severe acute pancreatitis in terms of hospital stay, need for surgical intervention, infections and mortality.
Doley
Rudra Prasad
RP
Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Yadav
Thakur Deen
TD
Wig
Jai Dev
JD
Kochhar
Rakesh
R
Singh
Gurpreet
G
Bharathy
Kishore Gurumoorthy Subramanya
KG
Kudari
Ashwini
A
Gupta
Rajesh
R
Gupta
Vikas
V
Poornachandra
Kuchhangi Sureshchandra
KS
Dutta
Usha
U
Vaishnavi
Chetna
C
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002177:Candidiasis / Q000209:etiology; D003131:Combined Modality Therapy; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000401:mortality / Q000628:therapy*; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods*; D012709:Serum Albumin / Q000032:analysis; D013514:Surgical Procedures, Operative; D015996:Survival Rate; D014168:Transferrin / Q000032:analysis; D016896:Treatment Outcome; D055815:Young Adult
D015415:Biomarkers; D012709:Serum Albumin; D014168:Transferrin; D002097:C-Reactive Protein