Enteral Nutrition by Percutaneous Endoscopic Gastrojejunostomy Tube (PEG-J) Tube in Pancreatitis: A Retrospective Study

Abstract

Introduction: Severe acute pancreatitis (SAP) and necrotizing pancreatitis (NP) or localized complications with infections account for > 40 % mortality in pancreatitis. Most studies evaluating enteral nutrition have utilized nasogastric, nasojejuneal or gastrostomy routes. We aimed to study the influence of enteral nutrition by PEG-J in mortality of patients with pancreatitis (SAP, NP and sterile/infected localized complications). Methods: Subjects with SAP and NP were collected retrospectively from a single tertiary care center by utilizing ICD-9 & ICD-10 codes. Each case was confirmed by manual review of the medical record. SAP and NP were defined per Revised Atlanta classification of acute pancreatitis 2012. Descriptive analysis was done by Excel & SPSS version 20. Results: All patients (79; 100%) with SAP or NP underwent PEG-J placement & were started on tube feeding immediately. Male 63%; Caucasians 96%, African American 4%, Age 56 ± 15 years & obesity (BMI ≥30) 38%. Etiologies were: Alcohol 30%, Biliary 38%, Idiopathic 23%. Distribution of subjects based on severity and morphological classification were as follows: SAP 43%, moderately-SAP 33% and mild AP were 24%. Interstitial pancreatitis or its local complications of acute peripancreatic fluid collection (APFC) or pseudocyst (PP) were present in 46%. Necrotizing pancreatitis or its local complications of acute necrotic collection (ANC) or walled-off necrosis (WON) were present in 37%. There were 11% of subjects with infected PP & 18% with infected WON/ANC. All patients but 2 achieved >75% of nutritional target. Gastrointestinal intolerance characterized by diarrhea, abdominal pain or both were present in 24% subjects, though the symptoms were transient & resolved spontaneously or with change of feeding formula. Standard tube feeding formulas were used. PEG-J malfunction was encountered in <0.5%. All-cause mortality was 12 (15%) and among this group 7 (9%) were related to pancreatitis related complications whereas 4 (5 %) patients opted for palliative care and 1 patient died of pancreatic cancer. Average ICU stay was 8 days & median hospital stay was 12 days. Subjects accounting for longer stay (≥ 30 days) in ICU or hospital were 9% & 25% respectively. Conclusion: Enteral nutrition by PEG-J decreases all cause and pancreatitis related mortality in patients with pancreatitis including SAP, NP or sterile/infected local complications (APFC, PP, ANC or WON).94 Figure 1. Comorbidities & Lab