title: Early versus on-demand nasoenteric tube feeding in acute pancreatitis.
abstract: BACKGROUND
  Early enteral feeding through a nasoenteric feeding tube is often used in patients with severe acute pancreatitis to prevent gut-derived infections, but evidence to support this strategy is limited. We conducted a multicenter, randomized trial comparing early nasoenteric tube feeding with an oral diet at 72 hours after presentation to the emergency department in patients with acute pancreatitis.
  
  
  METHODS
  We enrolled patients with acute pancreatitis who were at high risk for complications on the basis of an Acute Physiology and Chronic Health Evaluation II score of 8 or higher (on a scale of 0 to 71, with higher scores indicating more severe disease), an Imrie or modified Glasgow score of 3 or higher (on a scale of 0 to 8, with higher scores indicating more severe disease), or a serum C-reactive protein level of more than 150 mg per liter. Patients were randomly assigned to nasoenteric tube feeding within 24 hours after randomization (early group) or to an oral diet initiated 72 hours after presentation (on-demand group), with tube feeding provided if the oral diet was not tolerated. The primary end point was a composite of major infection (infected pancreatic necrosis, bacteremia, or pneumonia) or death during 6 months of follow-up.
  
  
  RESULTS
  A total of 208 patients were enrolled at 19 Dutch hospitals. The primary end point occurred in 30 of 101 patients (30%) in the early group and in 28 of 104 (27%) in the on-demand group (risk ratio, 1.07; 95% confidence interval, 0.79 to 1.44; P=0.76). There were no significant differences between the early group and the on-demand group in the rate of major infection (25% and 26%, respectively; P=0.87) or death (11% and 7%, respectively; P=0.33). In the on-demand group, 72 patients (69%) tolerated an oral diet and did not require tube feeding.
  
  
  CONCLUSIONS
  This trial did not show the superiority of early nasoenteric tube feeding, as compared with an oral diet after 72 hours, in reducing the rate of infection or death in patients with acute pancreatitis at high risk for complications. (Funded by the Netherlands Organization for Health Research and Development and others; PYTHON Current Controlled Trials number, ISRCTN18170985.).
authors.affiliation: The authors' affiliations are listed in the Appendix.
authors.forename: Olaf J
authors.initials: OJ
authors.lastname: Bakker
authors.forename: Sandra
authors.initials: S
authors.lastname: van Brunschot
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Bollen
authors.forename: Marja A
authors.initials: MA
authors.lastname: Boermeester
authors.forename: Cornelis H
authors.initials: CH
authors.lastname: Dejong
authors.forename: Harry
authors.initials: H
authors.lastname: van Goor
authors.forename: Koop
authors.initials: K
authors.lastname: Bosscha
authors.forename: Usama
authors.initials: U
authors.lastname: Ahmed Ali
authors.forename: Stefan
authors.initials: S
authors.lastname: Bouwense
authors.forename: Wilhelmina M
authors.initials: WM
authors.lastname: van Grevenstein
authors.forename: Joos
authors.initials: J
authors.lastname: Heisterkamp
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Houdijk
authors.forename: Jeroen M
authors.initials: JM
authors.lastname: Jansen
authors.forename: Thom M
authors.initials: TM
authors.lastname: Karsten
authors.forename: Eric R
authors.initials: ER
authors.lastname: Manusama
authors.forename: Vincent B
authors.initials: VB
authors.lastname: Nieuwenhuijs
authors.forename: Alexander F
authors.initials: AF
authors.lastname: Schaapherder
authors.forename: George P
authors.initials: GP
authors.lastname: van der Schelling
authors.forename: Matthijs P
authors.initials: MP
authors.lastname: Schwartz
authors.forename: B W Marcel
authors.initials: BW
authors.lastname: Spanier
authors.forename: Adriaan
authors.initials: A
authors.lastname: Tan
authors.forename: Juda
authors.initials: J
authors.lastname: Vecht
authors.forename: Bas L
authors.initials: BL
authors.lastname: Weusten
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Witteman
authors.forename: Louis M
authors.initials: LM
authors.lastname: Akkermans
authors.forename: Marco J
authors.initials: MJ
authors.lastname: Bruno
authors.forename: Marcel G
authors.initials: MG
authors.lastname: Dijkgraaf
authors.forename: Bert
authors.initials: B
authors.lastname: van Ramshorst
authors.forename: Hein G
authors.initials: HG
authors.lastname: Gooszen
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000368:Aged; D002149:Energy Intake; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications / Q000178:diet therapy* / Q000401:mortality; D019283:Pancreatitis, Acute Necrotizing / Q000209:etiology; D013997:Time Factors