title: Evaluation of early enteral feeding through nasogastric and nasojejunal tube in severe acute pancreatitis: a noninferiority randomized controlled trial.
abstract: OBJECTIVE
  This study aimed to determine the noninferiority of early enteral feeding through nasogastric (NG) compared to nasojejunal (NJ) route on infectious complications in patients with severe acute pancreatitis (SAP).
  
  
  METHODS
  Patients with SAP were fed via NG (candidate) or NJ (comparative) route. The primary outcome was the occurrence of any infectious complication in blood, pancreatic tissue, bile, or tracheal aspirate. Secondary end points were pain in refeeding, duration of hospital stay, intestinal permeability assessed by lactulose/mannitol excretion, and endotoxemia assessed by endotoxin core antibody types immunoglobulin G and M.
  
  
  RESULTS
  Seventy-eight patients were randomized to feeding by either the NG or the NJ route. During the hospital stay, the presence of any infectious complication in the NG and NJ groups was 23.1% and 35.9% (significantly different), respectively. The effect size of the difference of infectious complications was -12.8 (95% confidence interval, -29.6 to 4.0). The upper limit of the 95% confidence interval was 4.0 and was within the 5% limit set for noninferiority. The value of 8.0 for the number needed to treat implies that 8 patients should be treated with NG compared with the NJ group to prevent 1 patient from any of the infectious complications.
  
  
  CONCLUSIONS
  Early enteral feeding through NG was not inferior to NJ in patients with SAP. Infectious complications were within the noninferiority limit. Pain in refeeding, intestinal permeability, and endotoxemia were comparable in both groups.
authors.affiliation: Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Namrata
authors.initials: N
authors.lastname: Singh
authors.forename: Brij
authors.initials: B
authors.lastname: Sharma
authors.forename: Manik
authors.initials: M
authors.lastname: Sharma
authors.forename: Vikas
authors.initials: V
authors.lastname: Sachdev
authors.forename: Payal
authors.initials: P
authors.lastname: Bhardwaj
authors.forename: Kalaivani
authors.initials: K
authors.lastname: Mani
authors.forename: Yogendra Kumar
authors.initials: YK
authors.lastname: Joshi
authors.forename: Anoop
authors.initials: A
authors.lastname: Saraya
mesh_terms: D000208:Acute Disease; D000328:Adult; D001424:Bacterial Infections / Q000175:diagnosis / Q000209:etiology; D003428:Cross Infection / Q000175:diagnosis / Q000209:etiology; D019446:Endotoxemia / Q000175:diagnosis / Q000209:etiology; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010179:Pancreas / Q000382:microbiology / Q000473:pathology; D010195:Pancreatitis / Q000628:therapy*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult