A safe, effective, and cheap method of achieving pancreatic rest in patients with chronic pancreatitis with refractory symptoms and malnutrition.
OBJECTIVE
Chronic pancreatitis (CP) is common. It is associated with a substantial morbidity, including malnutrition, malabsorption, pseudocysts, metabolic disturbances, and intractable abdominal pain. Approximately 5% of patients with CP are refractory to nutritional support and opiate analgesia, making management challenging.Pancreatic rest can provide symptomatic relief. However, achieving simultaneous pancreatic rest and adequate nutritional support in these patients is difficult. We describe a technique for providing nutritional support and pancreatic rest in patients with intractable symptomatic CP.


METHODS
Three patients with symptomatic CP refractory to standard treatment were included in the study. All 3 patients had masses associated with the pancreas. Symptom relief and adequate nutritional support were achieved by inserting a long-term nasojejunal (NJ) tube (Flocare Bengmark, Nutricia Clinical Care, United Kingdom) under ambulatory endoscopic guidance. Data were recorded prospectively.


RESULTS
Long-term NJ tube feeding achieved pancreatic rest and significant symptomatic relief while delivering adequate nutritional support. Pseudocyst size decreased substantially in 2 patients. The third patient was found to have pancreatic carcinoma after pancreaticoduodenectomy.


CONCLUSIONS
In patients with symptomatic CP refractory to standard nutritional support and opiate analgesia, long-term NJ tube feeding can be a cheap, well-tolerated, safe, and effective method of providing adequate nutritional support and substantially relieving intractable symptoms.
Lordan
Jeffrey T
JT
HPB Unit, Royal Surrey County Hospital, Guildford, Surrey, United Kingdom. dr_lordan@yahoo.co.uk
Phillips
Mary
M
Chun
Joo-Young
JY
Worthington
Tim R
TR
Menezes
Neville N
NN
Lightwood
Robin
R
Hussain
Fuad
F
Tibbs
Christopher
C
Karanjia
Nariman D
ND
D000328:Adult; D004750:Enteral Nutrition / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods; D007583:Jejunum; D008297:Male; D044342:Malnutrition / Q000178:diet therapy* / Q000209:etiology*; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology; D010192:Pancreatic Pseudocyst / Q000150:complications / Q000178:diet therapy / Q000503:physiopathology; D050500:Pancreatitis, Chronic / Q000150:complications* / Q000178:diet therapy* / Q000503:physiopathology