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A randomized controlled trial of enteral versus parenteral feeding in patients with predicted severe acute pancreatitis shows a significant reduction in mortality and in infected pancreatic complications with total enteral nutrition.
Dig Surg. 2006; 23(5-6):336-44; discussion 344-5.DS

Abstract

BACKGROUND

Infectious complications are the main cause of late death in patients with acute pancreatitis. Routine prophylactic antibiotic use following a severe attack has been proposed but remains controversial. On the other hand, nutritional support has recently yielded promising clinical results. The aim of study was to compare enteral vs. parenteral feeding for prevention of infectious complications in patients with predicted severe acute pancreatitis.

METHODS

We screened 466 consecutive patients with acute pancreatitis. A total of 70 patients with objectively graded severe acute pancreatitis were randomly allocated to receive either total enteral nutrition (TEN) or total parenteral nutrition (TPN), within 72 h of onset of symptoms. Baseline characteristics were well matched in the two groups.

RESULTS

The incidence of pancreatic infectious complications (infected pancreatic necrosis, pancreatic abscess) was significantly lower in the enterally fed group (7 vs. 16, p = 0.02). In the TEN group, 7 patients developed multiple organ failure whereas 17 parenterally fed patients developed multiple organ failure (p = 0.02). Overall mortality was 20% with two deaths in the TEN group and twelve in the TPN group (p < 0.01).

CONCLUSION

Early TEN could be used as prophylactic therapy for infected pancreatic necrosis since it significantly decreased the incidence of pancreatic infectious complications as well as the frequency of multiple organ failure and mortality.

Authors+Show Affiliations

Department of Surgery, Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russia. max.petrov@gmail.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

17164546

Citation

Petrov, Maxim S., et al. "A Randomized Controlled Trial of Enteral Versus Parenteral Feeding in Patients With Predicted Severe Acute Pancreatitis Shows a Significant Reduction in Mortality and in Infected Pancreatic Complications With Total Enteral Nutrition." Digestive Surgery, vol. 23, no. 5-6, 2006, pp. 336-44; discussion 344-5.
Petrov MS, Kukosh MV, Emelyanov NV. A randomized controlled trial of enteral versus parenteral feeding in patients with predicted severe acute pancreatitis shows a significant reduction in mortality and in infected pancreatic complications with total enteral nutrition. Dig Surg. 2006;23(5-6):336-44; discussion 344-5.
Petrov, M. S., Kukosh, M. V., & Emelyanov, N. V. (2006). A randomized controlled trial of enteral versus parenteral feeding in patients with predicted severe acute pancreatitis shows a significant reduction in mortality and in infected pancreatic complications with total enteral nutrition. Digestive Surgery, 23(5-6), 336-44; discussion 344-5.
Petrov MS, Kukosh MV, Emelyanov NV. A Randomized Controlled Trial of Enteral Versus Parenteral Feeding in Patients With Predicted Severe Acute Pancreatitis Shows a Significant Reduction in Mortality and in Infected Pancreatic Complications With Total Enteral Nutrition. Dig Surg. 2006;23(5-6):336-44; discussion 344-5. PubMed PMID: 17164546.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomized controlled trial of enteral versus parenteral feeding in patients with predicted severe acute pancreatitis shows a significant reduction in mortality and in infected pancreatic complications with total enteral nutrition. AU - Petrov,Maxim S, AU - Kukosh,Mikhail V, AU - Emelyanov,Nikolay V, Y1 - 2006/12/12/ PY - 2006/04/03/received PY - 2006/06/24/accepted PY - 2006/12/14/pubmed PY - 2007/4/4/medline PY - 2006/12/14/entrez SP - 336-44; discussion 344-5 JF - Digestive surgery JO - Dig Surg VL - 23 IS - 5-6 N2 - BACKGROUND: Infectious complications are the main cause of late death in patients with acute pancreatitis. Routine prophylactic antibiotic use following a severe attack has been proposed but remains controversial. On the other hand, nutritional support has recently yielded promising clinical results. The aim of study was to compare enteral vs. parenteral feeding for prevention of infectious complications in patients with predicted severe acute pancreatitis. METHODS: We screened 466 consecutive patients with acute pancreatitis. A total of 70 patients with objectively graded severe acute pancreatitis were randomly allocated to receive either total enteral nutrition (TEN) or total parenteral nutrition (TPN), within 72 h of onset of symptoms. Baseline characteristics were well matched in the two groups. RESULTS: The incidence of pancreatic infectious complications (infected pancreatic necrosis, pancreatic abscess) was significantly lower in the enterally fed group (7 vs. 16, p = 0.02). In the TEN group, 7 patients developed multiple organ failure whereas 17 parenterally fed patients developed multiple organ failure (p = 0.02). Overall mortality was 20% with two deaths in the TEN group and twelve in the TPN group (p < 0.01). CONCLUSION: Early TEN could be used as prophylactic therapy for infected pancreatic necrosis since it significantly decreased the incidence of pancreatic infectious complications as well as the frequency of multiple organ failure and mortality. SN - 0253-4886 UR - https://www.unboundmedicine.com/medline/citation/17164546/A_randomized_controlled_trial_of_enteral_versus_parenteral_feeding_in_patients_with_predicted_severe_acute_pancreatitis_shows_a_significant_reduction_in_mortality_and_in_infected_pancreatic_complications_with_total_enteral_nutrition_ DB - PRIME DP - Unbound Medicine ER -