Short-term hemofiltration is cost-effective for severe acute pancreatitis

Oct 15 2007

Early nasogastric enteral nutrition is a breakthrough in the management of severe acute pancreatitis.

From meta-analysis based on current available clinical studies early nasogastric enteral nutrition appeared effective and safe in clinical practice.

Three randomized controlled clinical trials were eligible, and 131 participants were included. Of them, 67 were randomly assigned to the early nasogastric enteral nutrition group and 64 to the conventional nutritional route group. Conventional routes included total parenteral nutrition and nasojejunal enteral nutrition.

Nutritional management of severe acute pancreatitis is regarded as an indispensable approach. Total parenteral nutrition and gastrointestinal tract rest have been recommended in the management of severe acute pancreatitis since the mid 1990s. Enteral nutrition through jejuna route has been accepted as a safe and effective approach to the management of severe acute pancreatitis by preserving the integrity of intestinal mucosa and preventing bacterial translocation. Some studies have attempted to assess the feasibility and safety of early enteral nutrition through nasogastric route.

Early nasogastric enteral nutrition is a breakthrough in the management of severe acute pancreatitis. Previously, it was forbidden because it might potentially oppose the requirement of pancreatic rest in the acute inflammation phase. However, the present systematic review of three randomized controlled trials showed that nasogastric route does not worsen the clinical outcomes compared with the conventional total parenteral or jejunal enteral routes.

Gastrointestinal and pancreatic rest has been regarded as an important factor for management of severe acute pancreatitis. Nevertheless, nasogastric enteral nutrition disobeys this discipline. Whether the nasogastric route is able to gain similar results to gastrointestinal and pancreatic rest needs to be further investigated. If possible, serological, radiological or histological appraisal should be considered for the effectiveness and safety of early nasogastric enteral nutrition in the treatment of severe acute pancreatitis.

Nasogastric route is much more convenient in clinical practice. Moreover, it is obviously cheaper than nasojejunal tube placement. Based on the present results, nasogastric enteral nutrition can be applied in the early management of severe acute pancreatitis. However, before its application in clinical practice, further investigation is necessary to validate its effectiveness and safety.

The research group evaluated the effectiveness and safety of early nasogastric enteral nutrition for severe acute pancreatitis compared with conventional nutritional routes. Based on current studies, early nasogastric enteral nutrition appears effective and safe, but the available evidence is limited.