Realimentación digestiva en pancreatitis aguda: ¿cuándo y cómo? / Digestive refeeding in acute pancreatitis: when and how?

RESUMO

Background: Digestive refeeding in acute pancreatitis represent a dificult issue. It requires the rsolution of intestinal ileus and carries a risk of reactivation. Aim: To evaluate criteria that may guide in early refeeding avoiding unnecesary prolonged fasting. Patients and methods: Thirty patients with acute pancreatitis were evaluated in a prospective trial. The severity of the pancreatitis was evaluated according to APACHE II score and Balthazar CT scan altertions. The criteria proposed to start early refeeding were abscence of nausea and vomiting, decreased abdominal pain, presence of bowel sounds and lowering of serum amylase levels. Balthazar CT scan clasification, was used to decide between oral or enteral refeeding. Results. Eighty percent of patients had alterations in pancreatic density, necrosis or pancretic or peripancreatic liquid collections in the CT scan (correspondig to Balthazar stages C,D,or E). Ten patients fullfilled the criteria for enteral refeeding at 8.1 ñ 3.5 days (range 3 to 15 days), and 21 patients fulfilled criteria fo enteral refeeding at 8.7ñ4.5 (range 4-19). No patient had a reactivation of his pancreatitis. Conclusions . Digestive refeeding can be done safely by using the criteria proposed in this study. Pancreatic necrosis or peripancreatic fluid collections do not contraindicate refeeding. Oral feeding may be employed (as the first option) in selected patients, without increasing the riskof complication, regardless of CT scan alterations of the pancreas