Early versus delayed enteral feeding in acute pancreatitis
DOI:
https://doi.org/10.18203/2349-2902.isj20180808Keywords:
Acute pancreatitis, Enteral feedingAbstract
Background: Early enteral feeding through a nasoenteric feeding tube is often used in patients with acute pancreatitis, as compared to previous notion of pancreatic rest. This study aims to compare various outcomes of early and late enteral feeding in severe acute pancreatitis.
Methods: This study was a randomized trial conducted at Victoria hospital, Bengaluru between July 2016 and June 2017. Patients with severe acute pancreatitis were randomized into early enteral feeding and late enteral feeding groups in the ratio of 1:1. Early enteral feeding group were started on oral feeds within 24 hours of admission. Late enteral feeding group were started on oral feeds after 72 hours of admission. Patient demographics, clinical findings, investigations, length of hospital stay, complications were assessed and compared.
Results: In 124 out of 132 patients were included who met inclusion criteria. The mean age of patients was 28.6 years. There were 120 males (96.7%) and 4 females (3.2%). There were no significant differences in age, sex ratio and comorbidities between the two groups. Early enteral feeds group showed lesser number of gastrointestinal adverse effects after initiation of enteral feeds, lesser number of days taken to develop full tolerance to enteral feeds, lesser number of days of admission, lesser complications like necrotizing pancreatitis, single or multiple organs failure, lesser number of ICU admissions, requiring mechanical ventilation, including lesser mortality when compared to delayed enteral feeds group.
Conclusions: Patients with severe acute pancreatitis can safely be started on early enteral feeds within 24 hours of admission.
References
Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas 2006;33:323-30.
Banks PA, Freeman ML, Fass R, Baroni DS, Mutlu EA, Bernstein DE et al. Practice guidelines in acute pancreatitis. American Journal of Gastroenterology. 2006 Oct 1;101(10):2379-2400.
S. J. Pandol, A. K. Saluja, C. W. Imrie, P. A. Banks. Acute pancreatitis: bench to the bedside. Gastroenterology, vol. 132, no. 3, pp. 1127–1151, 2007.
B. W. M. Spanier, M. G. W. Dijkgraaf, M. J. Bruno, Epidemiology, aetiology and outcome of acute and chronic pancreatitis: an update. Best Pract Res Clin Gastroenterol. 2008;22(1):45-63.
Singh VK, Bollen TL, Wu BU, et al. An assessment of the severity of interstitial pancreatitis. Clin Gastroenterol Hepatol 2011;9:1098-103.
Whitcomb DC. Acute pancreatitis. N Engl J Med 2006;354:2142-50.
Besselink MG, van Santvoort HC, Boermeester MA, et al. Timing and impact of infections in acute pancreatitis. Br J Surg 2009;96:267-73.
Wu BU, Johannes RS, Kurtz S, Banks PA. The impact of hospital-acquired infection on outcome in acute pancreatitis. Gastroenterology 2008;135:816-20.
Rodriguez JR, Razo AO, Targarona J, et al. Debridement and closed packing for sterile or infected necrotizing pancreatitis: insights into indications and outcomes in 167 patients. Ann Surg 2008;247:294-9.
C. E. Forsmark, J. Baillie. AGA Institute technical review on acute pancreatitis. Gastroenterology. 2007 May;132(5):2022-44.
M. S. Petrov, R. D. Pylypchuk, N. V. Emelyanov. Systematic review: nutritional support in acute pancreatitis. Aliment Pharmacol Ther. 2008 Sep 15;28(6):704-12
O. Ioannidis, A. Lavrentieva, D. Botsios. Nutrition support in acute pancreatitis. JOP. J Pancreas 2008; 9(4):375-390.
R. Talukdar, S. S. Vege. Recent developments in acute pancreatitis. Clin Gastroenterol Hepatol. 2009 Nov;7(11 Suppl):S3-9
Besselink MG, van Santvoort HC, Boermeester MA, Nieuwenhuijs VB, van Goor H, Dejong CH, et al. Timing and impact of infections in acute pancreatitis. Br J Surg. 2009 Mar;96(3):267-73.
Kreymann KG, Berger MM, Deutz NE, et al. ESPEN guidelines on enteral nutrition: intensive care. Clin Nutr 2006;25: 210-23.
Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr 2003;27:355-73.
Koretz RL, Lipman TO. The presence and effect of bias in trials of early enteral nutrition in critical care. Clin Nutr 2014; 33:240-5.
Casaer MP, Van den Berghe G. Nutrition in the acute phase of critical illness. N Engl J Med 2014;370:1227-36.
Petrov MS, Pylypchuk RD, Uchugina AF. A systematic review on the timing of artificial nutrition in acute pancreatitis. Br J Nutr 2009; 101: 787-793
Marik PE. What is the best way to feed patients with pancreatitis? Curr Opin Crit Care 2009; 15: 131-138
Sun JK, Mu XW, Li WQ, Tong ZH, Li J, Zheng SY. Effects of early enteral nutrition on immune function of severe acute pancreatitis patients. World J Gastroenterol 2013; 19: 917-922
