Abstract
Objective:To compare the efficacy and safety of early nasogastric enteral nutrition (EN) with total parenteral nutrition (TPN) in patients with severe acute pancreatitis (SAP).Methods:From July 2008 to July 2014,185 patients with SAP admitted to our centre were enrolled in this retrospective study. They were divided into EN group (n=89) and TPN group (n=96) based on the nutrition support modes. Patients in EN group received nasogastric EN support, while patients in TPN group received TPN support within 72 hours of disease onset. The medical records were reviewed and clinical factors were retrospectively analyzed.Results:There were no significant differences in baseline characteristics between two groups. EN group had significantly lower incidence of pancreatic infections (P=0.0333) and extrapancreatic infections (P=0.0431). Significantly shorter hospital stay (P=0.0355) and intensive-care stay (P=0.0313) were found in EN group. TPN group was found to have significantly greater incidence of multiple organ dysfunction syndrome (MODS) (P=0.0338) and mortality (P=0.0382). Moreover, the incidence of hyperglycemia was significantly higher in TPN group (P=0.0454).Conclusions:Early nasogastric EN was feasible and significantly decreased the incidence of infectious complications as well as the frequency of MODS and mortality caused by SAP.
Highlights
Severe acute pancreatitis (SAP) is a common cause of emergency hospital admission,[1] with an increase in the incidence during the past 30 years, which can induce vascular leakage, shock, systemic inflammatory response syndrome, organ dysfunctions and even mortality.[2,3] Nutritional support should be an integral part of patient care and started early in the course of disease.[4,5] Theoretically, enteral nutrition (EN) should minimize the incidence of infectious complications in patients with SAP, as it probably reduces bacterial translocation and the consequent sepsis by enhancing intestinal barrier function.[6]
Pancreatic and Extrapancreatic Infectious Complications: The incidence of pancreatic infections was significantly lower in EN group (12/89 vs. 25/96, P=0.0333). (Table-II)
The second peak in mortality usually involves multiple organ dysfunction syndrome (MODS) together with infections, which are frequently caused by gram-negative bacteria
Summary
Severe acute pancreatitis (SAP) is a common cause of emergency hospital admission,[1] with an increase in the incidence during the past 30 years, which can induce vascular leakage, shock, systemic inflammatory response syndrome, organ dysfunctions and even mortality.[2,3] Nutritional support should be an integral part of patient care and started early in the course of disease.[4,5] Theoretically, enteral nutrition (EN) should minimize the incidence of infectious complications in patients with SAP, as it probably reduces bacterial translocation and the consequent sepsis by enhancing intestinal barrier function.[6]. On the basis of aforementioned facts, we conducted this retrospective study to evaluate the efficacy and safety of early nasogastric enteral nutrition as compared with TPN in patients with SAP
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