Early nasojejunal tube feeding versus nil-by-mouth in acute pancreatitis: A randomized clinical trial.
OBJECTIVE
There is substantial evidence of superiority of enteral nutrition (EN) to parenteral nutrition in acute pancreatitis (AP) treatment, but few studies evaluated its effectiveness compared to no intervention. The objective of our trial was to compare the effects of EN to a nil-by-mouth (NBM) regimen in patients with AP.


METHODS
Patients with AP were randomized to receive either EN via a nasojejunal tube initiated within 24 h of admission or no nutritional support. Systemic inflammatory response syndrome (SIRS) was assessed as the primary outcome. Secondary outcomes included mortality, organ failure, local complications, infected pancreatic necrosis, surgical interventions, length of hospital stay, adverse events and inflammatory response intensity. Outcomes were compared using Student's t-test and Mann-Whitney U test as appropriate.


RESULTS
214 patients were randomized in total, 107 to each group. SIRS occurrence was similar between groups, with 48 (45%) versus 51 (48%), respectively (RR 0.94; 95% CI 0.71-1.26). No significant reduction of persistent organ failure (RR 0.81; 95% CI 0.52-1.27) and mortality (RR 0.59; 95% CI 0.28-1.23) was present in the EN group. There were no significant differences in other outcomes between the groups. When analyzing the occurrence of SIRS and mortality in subgroup of patients with severe disease no significant differences were noted.


CONCLUSIONS
Our results showed no significant reduction of persistent organ failure and mortality in patients with AP receiving early EN compared to patients treated with no nutritional support (NCT01965873).
Department of Gastroenterology, Faculty of Medicine Rijeka, University Hospital Rijeka, Rijeka, Croatia.
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D
Stimac
Department of Gastroenterology, Faculty of Medicine Rijeka, University Hospital Rijeka, Rijeka, Croatia. Electronic address: goran.poropat@medri.uniri.hr.
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G
Poropat
Department of Gastroenterology, Faculty of Medicine Rijeka, University Hospital Rijeka, Rijeka, Croatia.
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G
Hauser
Department of Gastroenterology, Faculty of Medicine Rijeka, University Hospital Rijeka, Rijeka, Croatia.
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V
Licul
Department of Gastroenterology, Faculty of Medicine Rijeka, University Hospital Rijeka, Rijeka, Croatia.
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N
Franjic
Department of Radiology, Faculty of Medicine Rijeka, University Hospital Rijeka, Rijeka, Croatia.
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P
Valkovic Zujic
Department of Gastroenterology, Faculty of Medicine Rijeka, University Hospital Rijeka, Rijeka, Croatia.
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S
Milic
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007583:Jejunum; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D009296:Nasal Cavity; D019283:Pancreatitis, Acute Necrotizing / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology; D016896:Treatment Outcome
Acute necrotizing; Complications; Enteral nutrition; Fasting; Mortality; Pancreatitis