ABSTRACT
Background and Objectives: Severe acute pancreatitis (SAP) affects the nutritional status of the patient. This prospective study was carried to assess the tolerance and outcome of early enteral nutrition via naso-jejunal feeding tube (NJFT).Methods: 30 patients of SAP were given enteral feeding via endoscopically inserted NJFT within 48 – 72 hours of admission. The volume of the feeds was increased as per tolerance. The patients who tolerated the feed (Group A) and those who did not tolerate (Group B) were followed up by biochemical parameters, amount and duration of feeding. The patient outcome noted and the results statistically analyzed. Results: 27 (90%) patients tolerated the feed, reached the goal feed volume and were subsequently started on oral feeds. No complication related to NJFT insertion was encountered. A significantly higher ICU stay (p=0.04) and number of complications (p = 0.048) was observed in Group B patients than in Group A. All nutritional parameters improved in patients in Group A with significant improvement in serum calcium, serum albumin and fasting blood glucose levels. Conclusion: Enteral nutrition is an economical and effective way to provide nutrition to patients with severe acute pancreatitis. The patients who tolerated feeds had less morbidity, mortality and hospital stay.
ABSTRACT
Background and Objectives: Around 20% of the patients of acute pancreatitis develop acute severe pancreatitis in the form of extensive pancreatic or peripancreatic fat tissue necrosis with associated peripancreatic collections. These patients run a protracted clinical course, multiorgan failure, high morbidity and mortality. Methods: Clinically and radiologically diagnosed 30 patients of acute severe necrotizing pancreatitis were prospectively evaluated for the clinical outcome with respect to extent of pancreatic necrosis and severity in terms of CTSI. Results: 18 patients had pancreatic necrosis between 30-50% (Group A) whereas 12 patients had necrosis more than 50% (Group B). The rate of organ dysfunction and mortality (11.11% versus 50.50%) the rate of was significantly higher in the group B. Multiorgan failure (MOF) was present in 5.56% of group A and 58.33% of group B patients. 66.67% patients were managed conservatively of whom 80% survived and 33.33% patients underwent surgical intervention of whom 60% survived. Conclusion: CECT is the modality of choice to help stage the severity of pancreatic necrosis, depict severity of inflammatory processes and local complications. Patients with pancreatic necrosis with transient end organ dysfunction can be treated conservatively with favorable outcome. The need for intervention should be individualized and based on the clinical condition of patient.