Feasibility of self-propelling nasojejunal feeding tube in patients with acute pancreatitis.

BACKGROUND & AIMS: To assess the success rate of a self-propelling nasojejunal feeding tube in patients with acute pancreatitis. METHODS: All patients admitted for acute pancreatitis were included. A self-propelling nasojejunal feeding tube was introduced into the stomach, and gastrointestinal motility was stimulated using metoclopramide. If the tube failed to advance to the ligament of Treitz, a nasojejunal tube was placed endoscopically. RESULTS: A total of 108 patients, 94 with necrotizing pancreatitis (Balthazar D/E) and 14 with nonnecrotizing pancreatitis (Balthazar B/C), were referred for artificial nutrition. In 11 cases, ileus persisted and parenteral nutrition was initiated. Among the remaining 97 patients, 5 refused tube placement. The self-propelling feeding tube was inserted in 92 patients with successful migration to the ligament of Treitz in 61% (n = 56) and failure in 39% (n = 36). Of the 36 patients with an initial failed placement, endoscopic placement of a nasojejunal tube was successful 80% of the time (29 patients). The success rate of a nasojejunal self-propelling feeding tube placement correlated directly with the severity of the acute pancreatitis (92% in B/C vs 61% in D vs 48% in E; P < .05). CONCLUSIONS: Use of a self-propelling nasojejunal tube is a simple technique that can be successfully performed in the majority of patients with acute pancreatitis. The utility of this procedure in the most severe cases of acute pancreatitis continues to pose a challenge.

Semi-elemental formula or polymeric formula: is there a better choice for enteral nutrition in acute pancreatitis? Randomized comparative study.

BACKGROUND: Jejunal nutrition is recommended during acute pancreatitis. The use of semi-elemental formulas presents several theoretical advantages over polymeric formulas, but their clinical value has been poorly documented. Our aim was to evaluate in patients with acute pancreatitis the effect of enteral nutrition by a semi-elemental formula compared with a polymeric formula. METHODS: A randomized prospective pilot study, stratified according to severity, was performed in 30 consecutive patients with acute pancreatitis requiring jejunal nutrition. The semi-elemental group received 35 kcal/kg/d of Peptamen (n = 15), and the polymeric group received the same quantity of Sondalis-Iso (n = 15). Tolerance was evaluated after 7 days of enteral nutrition (D7) on visual analog scale (VAS), stool frequency, and 24-hour steatorrhea/creatorrhea. Outcome was evaluated by weight loss, length of hospital stay, and infection rate. RESULTS: Results were calculated as mean +/- SEM, t-test, or chi2. Patients of the 2 groups were comparable in terms of age, gender, and severity. Tolerance was good in both groups (semi-elemental vs polymeric: VAS, 7.4 +/- 0.6 vs 7.1 +/- 0.6, not significant (NS); number of stools per 24 hours, 1.7 +/- 0.4 vs 1.8 +/- 0.4, NS). Steatorrhea and creatorrhea were lower than normal in both groups. In semi-elemental group, the length of hospital stay was shorter (23 +/- 2 vs 27 +/- 1, p = .006) and weight loss was less marked (1 +/- 1 vs 2 +/- 0, p = .01). One patient in semi-elemental group and 3 patients in polymeric group developed an infection (NS). CONCLUSIONS: Semi-elemental and polymeric nutrition are very well tolerated in patients with acute pancreatitis. Nutrition with a semi-elemental formula supports the hypothesis of a more favorable clinical course than nutrition with a polymeric formula, but this conclusion needs to be established in larger adequately powered clinical trials.

What is the risk of nocturnal supine enteral nutrition?

UNLABELLED: One complication of enteral nutrition (EN) is gastro-esophageal reflux disease. Semi-recumbent position is advised because posture influence reflux in critically ill patients. No data is available in stable patients. AIM: To study influence of position on reflux during nocturnal nutrition by percutaneous endoscopic gastrostomy in stable patients. METHODS: Prospective cross-over study. Reflux was measured by 48 h-pH-metry, in supine and semi-recumbent position. The end point was % time spent under pH 4. For analysis, 2 subgroups were identified (refluxers and non-refluxers). A total of 16 patients (65 year+/-13) were included, most had neurological diseases. RESULTS: There was no increase of reflux probability in any position in all patients (% time spent under pH 4: supine vs. semi-recumbent: 4.4+/-7.7 vs. 3.5+/-7.0 NS). In non-refluxers, supine position did not increase % time under pH 4 (0.1+/-0.12 vs. 0.3+/-0.6, NS), and did not modify other parameters (number of reflux 0 +/-0.9 vs. 7 +/-19 NS, duration of the longest reflux (min) 1.1+/-1.7 vs. 1+/-1.7 NS). In refluxers, supine position did not worsen pre-existent reflux (% time under pH 4: 11.7+/-8.7 vs. 8.9+/-9.7 NS, number of reflux 119+/-88 vs. 91+/-89 NS, duration of the longest reflux (min) 19+/-19 vs. 24+/-21 NS). CONCLUSION: Our data suggest that position does not influence reflux in stable patients with EN.