title: Nasogastric or nasointestinal feeding in severe acute pancreatitis.
abstract: OBJECTIVE
  To assess the rate of spontaneous tube migration and to compare the effects of naso-gastric and naso-intestinal (NI) (beyond the ligament of Treitz) feeding in severe acute pancreatitis (SAP).
  
  
  METHODS
  After bedside intragastric insertion, tube position was assessed, and enteral nutrition (EN) started at day 4, irrespective of tube localization. Patients were monitored daily and clinical and laboratory parameters evaluated to compare the outcome of patients with nasogastric (NG) or NI tube.
  
  
  RESULTS
  Spontaneous tube migration to a NI site occurred in 10/25 (40%) prospectively enrolled SAP patients, while in 15 (60%) nutrition was started with a NG tube. Groups were similar for demographics and pancreatitis aetiology but computed tomography (CT) severity index was higher in NG tube patients than in NI (mean 6.2 vs 4.7, P = 0.04). The CT index seemed a risk factor for failed obtainment of spontaneous distal migration. EN trough NG or NI tube were similar in terms of tolerability, safety, clinical goals, complications and hospital stay.
  
  
  CONCLUSIONS
  Spontaneous distal tube migration is successful in 40% of SAP patients, with higher CT severity index predicting intragastric retention; in such cases EN by NG tubes seems to provide a pragmatic alternative opportunity with similar outcomes.
authors.affiliation: Digestive and Liver Disease Unit, II Medical School, University Sapienza, S. Andrea Hospital, Via Di Grottarossa 1035, Rome, Italy. gianfranco.dellefave@uniroma1.it
authors.forename: Matteo
authors.initials: M
authors.lastname: Piciucchi
authors.forename: Elettra
authors.initials: E
authors.lastname: Merola
authors.forename: Massimo
authors.initials: M
authors.lastname: Marignani
authors.forename: Marianna
authors.initials: M
authors.lastname: Signoretti
authors.forename: Roberto
authors.initials: R
authors.lastname: Valente
authors.forename: Lucia
authors.initials: L
authors.lastname: Cocomello
authors.forename: Flavia
authors.initials: F
authors.lastname: Baccini
authors.forename: Francesco
authors.initials: F
authors.lastname: Panzuto
authors.forename: Gabriele
authors.initials: G
authors.lastname: Capurso
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Delle Fave
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005548:Foreign-Body Migration; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000178:diet therapy*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult