Is intragastric administration of enteral nutrition safe in acute severe pancreatitis?

Introduction

Enteral nutrition is the standard of nutritional support in acute severe pancreatitis. Nutrients are routinely delivered below the Treitz angle either by jejunostomy or by an endoscopically placed nasojejunal tube. In recent years the safety of intragastric delivery was under scrutiny [1]. Our study aimed to evaluate the characteristics of intragastric nutrition and its safety in acute severe pancreatitis.

Methods

The retrospective study included all patients with acute severe pancreatitis (admission APACHE II score >12) admitted to an emergency university hospital during a 3-year period (2005 to 2007). Nutritional support was assessed as type, route and timing. Collected data were age, admission and highest severity scores, intraabdominal pressure, antibiotic use, surgery, ICU and hospital lengths of stay, and outcome. The safety of intragastric nutrition was assessed as the outcome.

Results

Forty-two patients were enrolled. Enteral nutrition was used in 25 patients (59.5%). The majority (20 patients, 80%) received at least for several days associated parenteral nutrition until the caloric needs could be met by the enteral route. Route of administration: intragastric, 16 patients (only oral intake, nine patients; nasogastric tube, five patients; combined oral and jejunostomy, two patients) and only jejunostomy, nine patients. No patient had a nasojejunal tube. Intragastric nutrition started on the 4.4th hospital day (mean value) (range 2 to 10 days). There were no statistically significant differences between patients with intragastric versus jejunal nutrition concerning the demographics and severity scores on admission. The patients with intragastric nutrition compared with the jejunostomy group had a significantly lower rate of surgery (31.2% vs. 100%, P < 0.01), antibiotic use (81.2% vs. 100%, P = 0.05) and lower mortality rate (25% vs. 55.5%, P = 0.01).

Conclusion

Despite the classical presumption that gastric nutrition may worsen the evolution of acute severe pancreatitis, our study shows that intragastric administration does not increase mortality. Even more, compared with jejunostomy, it is associated with improved outcome, a lower rate of surgical interventions, and less antibiotic use.