Nasogastric or nasointestinal feeding in severe acute pancreatitis.
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.
Piciucchi
Matteo
M
Digestive and Liver Disease Unit, II Medical School, University Sapienza, S. Andrea Hospital, Via Di Grottarossa 1035, Rome, Italy. gianfranco.dellefave@uniroma1.it
Merola
Elettra
E
Marignani
Massimo
M
Signoretti
Marianna
M
Valente
Roberto
R
Cocomello
Lucia
L
Baccini
Flavia
F
Panzuto
Francesco
F
Capurso
Gabriele
G
Delle Fave
Gianfranco
G
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