title: Impact of Nasojejunal Feeding on Outcome of Patients with Walled Off Pancreatic Necrosis (WOPN) Presenting with Pain: a Pilot Study.
abstract: BACKGROUND
  Drainage is usually recommended in symptomatic walled off pancreatic necrosis (WOPN). WOPN presenting with pain may get symptomatic relief if the pancreas is given rest by initiating nasojejunal (NJ) feed.
  
  
  OBJECTIVE
  The aim of this was to prospectively study the efficacy of nasojejunal (NJ) feeding in patients of WOPN presenting with abdominal pain.
  
  
  METHODS
  Twenty-one patients (15 M; 35 ± 12 years) with WOPN (size 7-16 cm) presenting with pain underwent NJ tube placement under endoscopic guidance. Following this, pain relief and long-term outcome were studied.
  
  
  RESULTS
  Etiology of pancreatitis was alcohol in 12, gall stones in 6, and idiopathic in 3 patients. NJ tube was successfully placed in all patients and 17/21 (81%) patients had symptomatic relief in 1-4 days (mean 2 ± 1 days) following NJ feeding. NJ tube was removed after 7-10 days (mean 7 ± 1 days), and 14 (61%) patients remained pain free and follow-up imaging (1-8 months) revealed complete resolution or decrease in size of WOPN. Three patients had recurrence of pain and were successfully treated with endoscopic drainage.
  
  
  CONCLUSIONS
  NJ feeding improves pain in the majority of patients with WOPN and thus obviates or delays drainage. Majority of nonresponders had disconnected pancreatic duct syndrome (DPDS).
authors.affiliation: Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India.
authors.forename: Surinder S
authors.initials: SS
authors.lastname: Rana
authors.forename: Vinita
authors.initials: V
authors.lastname: Chaudhary
authors.forename: Ravi
authors.initials: R
authors.lastname: Sharma
authors.forename: Vishal
authors.initials: V
authors.lastname: Sharma
authors.forename: Puneet
authors.initials: P
authors.lastname: Chhabra
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Bhasin
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000628:therapy*; D000328:Adult; D004322:Drainage; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods; D007583:Jejunum; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology / Q000628:therapy; D010179:Pancreas / Q000473:pathology*; D010195:Pancreatitis / Q000150:complications; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome