DOI: http://dx.doi.org/10.18203/2349-2902.isj20192280

Clinical outcome in low socioeconomic patients with severe acute pancreatitis treated either with early nasogastric tube or total parenteral nutrition: a randomized controlled trial

Anil Kumar, Shiv S. Paswan, Shiv Kishor, Vimal Bhandari

Abstract


Background: Early nasogastric feeding has shown beneficial effect in the low socioeconomic group of patient with severe acute pancreatitis (SAP). The current randomized controlled study was performed to assess the effect of early nasogastric feeding as compared to total parenteral nutrition (TPN).

Methods: Fifty patients admitted with diagnosis of SAP were randomly allocated to receive nnteral feeding (EF) (at the rate of 25 ml/hour and was gradually increased up to 100 ml/hr) or TPN within 24 hours of hospital admission. The nutritional regimen was aimed to be iso-caloric between the two groups. Patient’s demographics, hospital stay, nutrition, total cost, complication, and mortality were observed for 1 month in follow up.

Results: All fifty patients were completed the study. Patient demographics were similar in both groups. 38/50 belonged to low socioeconomic status in the study group (Twenty in EF and eighteen in TPN group). The complications were significantly lower in EF group (pancreatic infection (11 vs. 4, p=0.037), central venous catheter infection (EF=0 vs. TPN=8, p=0.002), multiorgan failure (EF=5, TPN=12, p=0.037). Early recovery in EF group was significant with the mean duration of hospital stay of 6.76 days as compared to 10.4 days in the TPN group. The mean expenditure in the EF group was 1268 as compared to 13688 Indian rupees in the TPN group.

Conclusions: This study shows that early EF improves early recovery, lower complications and cost effective measure in SAP especially in low socioeconomic group of patients.


Keywords


Pancreatitis, Enteral feeding, TPN, Low-socioeconomic

Full Text:

PDF

References


Popa CC, Badiu DC, Rusu OC, Grigorean VT, Neagu SI, Strugaru CR. Mortality prognostic factors in acute pancreatitis. J Med Life. 2016;9(4):413-8.

Kotán R, Pósán J, Sápy P, Damjanovich L, Szentkereszty Z. Analysis of clinical course of severe acute biliary and non biliary pancreatitis: a comparative study. Orv Hetil. 2010;151(7):265–8.

Bhatia M. Novel therapeutic targets for acute pancreatitis and associated multiple organ dysfunction syndrome. Current Drug Targets Inflammation Allergy. 2002;1(4):343–51.

Windsor JA, Hammodat H. Metabolic management of severe acute pancreatitis. World J Surg. 2000;24(6):664–72.

Olah A, Romics L Jr. Enteral nutrition in acute pancreatitis: A review of the current evidence. World J Gastroenterol. 2014;20(43):16123-31.

Eatock FC, Chong P, Menezes N, Murray L, Mckay CJ, Carter CR, et al. A randomised study of early nasogastric versus nasojejunal feeding in severe acute pancreatitis. AM J Gastroenterol. 2005;100(2):432-9.

Windsor AC, Kanwar S, Li AG, Barnes E, Guthrie JA, Spark JI, et al. Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut. 1998;42(3):431-5.

Kalfarentzos F, Kehagias J, Mead N, Kokkinis K, Gogos CA. Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis; result of a randomised prospective trial. Br J Surg. 1997;84(12):1665-9.

Swank GM, Deitch EA. Role of gut in multiple organ organ failure: bacterial translocation and permeability changes. World J Surg. 1996;20(4):411-7.

Gupta R, Patel K, Calder PC, Yaqoob P, Primerose JN, Jonhson CD. A randomised clinical trial to assess the effect of total enteral and parenteral nutrition support on pancreatitis. (APACHE II; 6). Pancreatology. 2003;3(5):406-13.

Eckerwall G.E, Axelsson J.B, Andersson R.G. Early Nasogastric Feeding in Predicted Severe Acute Pancreatitis.A Clinical Randomized Study. Ann Surg. 2006;244(6):959-67.

Bradley EL 3rd, Allen K. A prospective longitudinal study of observation versus surgical intervention in the management of necrotising pancreatitis. Am J Surg. 1991;161(1):19-25.

Olah A, Pardavi G, Belagyi T, Nagy A, Issekutz A, Mohamed GE. Early nasojejunal feeding in acute pancreatitis is associated with a lower complication rate. Nutrition. 2002;18(3):259-262.

Beger HG, Buchler M, Bittner R, Block S, Nevalainen T, Roscher R. Necrosectomy and postoperative local lavage in necrotizing pancreatitis. Br J Surg. 1988;75(3):207-12.

Isenmann R, Runzi M, Kron M, Kahl S, Kraus D, Jung N, et al. Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo -controlled, double blind trial. Gastroenterology. 2004;126(4):997-1004.

Marik PE, Zaloga GP. Meta analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis. BMJ. 2004;328:1407-13.

Powell J, Murchison T, Fearon KC, Ross JA, Siriwardena AK. Randomized controlled trial of the effect of early enteral nutrition on markers of the inflammatory response in predicted severe acute pancreatitis. Br J Surg. 2000;87:1375–81.

Petrov MS, Atduev VA, Zagainov VE. Advanced enteral therapy in acute pancreatitis: Is there a room for immunonutrition? A meta-analysis. Int J Surg. 2008;6(2):119-24.

Meier R, Ockenga J, Pertkiewicz M, Pap A, Milinic N, Macfie J. ESPEN guidelines on enteral nutrition: pancreas. Clin Nutr. 2006;25(2):275–84.

Spanier BW, Bruno MJ, Mathus-Vliegen EMH. Enteral Nutrition and Acute Pancreatitis: A Review. Gastroenterol Res Pract. 2011;2011:857949.