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JOP. 2009 Mar 9;10(2):157-62.

Enteral nutrition in severe acute pancreatitis.

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1
Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Abstract

CONTEXT:

There is controversy concerning the merits of enteral and parenteral nutrition in the management of patients with severe acute pancreatitis.

OBJECTIVE:

This study was undertaken to evaluate the effect of enteral nutrition versus parenteral nutrition on serum markers of inflammation and outcome in patients with severe acute pancreatitis.

SETTING:

Tertiary care centre in North India.

DESIGN:

A prospective clinical trial.

METHODS:

Fifty consecutive patients with severe acute pancreatitis were randomized in a prospective trial to receive total enteral nutrition (n=25) or total parenteral nutrition (n=25). Enteral nutrition was delivered distal to the ligament of Treitz. Serum C-reactive protein, transferrin levels, albumin, surgical intervention, infections, duration of hospital stay and mortality were compared in the two groups.

RESULTS:

The mean age in the enteral nutrition group was 38.4+/-13.8 years and in the total parenteral nutrition group 41.1+/-11.3 years. The etiological factors were alcohol (n=19), gallstones (n=23), idiopathic (n=7) and drug-induced (n=1). There was a significant decrease in serum C-reactive protein values in both the enteral nutrition group and the total parenteral nutrition group at one week and two weeks (P<0.001 for both). Serum albumin rose from a prenutritional value of 2.82+/-0.51 g/dL to 3.34+/-0.45 g/dL on day 14 of nutritional support in the enteral nutrition group (P=0.003); in the total parenteral nutrition group, the level rose from 3.10+/-0.59 g/dL to 3.21+/-0.30 g/dL (P=0.638). A significant rise in transferrin value was observed from day 0 to day 14 in enteral nutrition group (169+/-30 to 196+/-36 mg/dL; P<0.001) whereas, in the total parenteral nutrition group, a less significant difference (191+/-41 to 201+/-29 mg/dL; P=0.044) was observed. There was no significant difference in surgical intervention (56.0% versus 60.0%; P=1.000), infective complications (64.0% versus 60.0%; P=1.000), hospital stay (42 days, 15-108 days, versus 36 days, 20-77 days; median, range; P=0.755), or mortality (20.0% versus 16.0%; P=1.000) in enteral nutrition versus total parenteral nutrition, respectively.

CONCLUSION:

Enteral nutrition and total parenteral nutrition are comparable in the management of severe acute pancreatitis in terms of hospital stay, need for surgical intervention, infections and mortality.

PMID:
19287109
[Indexed for MEDLINE]
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