Comparative study of early enteral feeding versus parenteral feeding in acute severe pancreatitis in JSS hospital

Abstract

Background: Acute Severe acute pancreatitis is found in 20-30% of patients with pancreatitis and is associated with marked increased risk of complications, such as necrosis, abscess, formation of pancreatic pseudocyst and multiorgan failure, and also the disease manifests with a “systemic inflammatory response syndrome (SIRS) that culminates with hyper metabolism and high rate of protein catabolism; consequently, nutritional reserves are rapidly consumed and malnutrition may ensue unless a higher nutritional intake is provided, thus, early nutritional support plays a central role in the management of these patients. Parenteral nutritional support has long been the standard source of exogenous nutrients for these patients; however this is associated with many disadvantages, including dysfunction of the intestinal mucosal barrier, which, in turn, promotes sepsis of intestinal origin. Enteral nutrition, on the other hand, can maintain the integrity and function of the intestinal mucosal barrier, and thus the study intends to compare the efficacy of enteral versus parenteral feeding in influencing the outcomes in acute pancreatitis cases measured in terms of acute phase proteins, duration of ICU care, length of hospital stay.Aim: To compare the efficacy of enteral feeds versus parenteral feeding in terms of, outcomes of acute pancreatitis patients, to assess acute phase response in both types of feeding and measuring the length of hospital stay including length of ICU stay.Methods: Patients admitted with diagnosis of acute pancreatitis will be randomly grouped into group A and B by odd and even number hospital admission, Sample Size is considered as 100 with 50 in group A receiving enteral feeding and 50 in group B receiving parenteral feeding, considering the mean difference in hospital stay of 6 days and SD in each group as 12 days.Results: It was seen that patients who received early enteral nutrition had better outcomes in terms of acute phase proteins, shorter length of hospital stay (p-value:0.038, t-test:7.868) and shorter length of ICU care (p-value: 0.044, t-test:1.094) that compared with total parenteral nutrition group.Conclusion: It can be concluded that in our study, early enteral nutrition can be started safely and efficient when started “within 48 hours of admission” which had better outcomes in terms of acute phase proteins, shorter duration of ICU care and length of hospital stay and also cost effective that compared to those patients who received total parenteral nutrition where lesser patients showed better outcomes, had increased hospital stay and was costlier.