Nasogastric feeding in severe acute pancreatitis may be practical and safe

Background. Severe acute pancreatitis may be protracted and some form of nu tritional support is frequently required to maintain the patient's nutritio nal status. Recent work has suggested that enteral feeding via a jejunal ro ute of delivery may reduce the magnitude of the inflammatory response. Inse rtion of naso-jejunal (NJ) tubes in the patient with severe acute pancreati tis involves both delay and inconvenience. We undertook a prospective, feas ibility study to assess the safety and practicability of nasogastric (NG) f eeding in patients with severe acute pancreatitis. Patients and Methods. Twenty-six patients with objective evidence of severe acute pancreatitis received nasogastric feeding within 48 h of admission t o our unit. Results. Etiology was identified as cholelithiasis (18 patients), ethanol ( 5), and miscellaneous (3). The median Glasgow score was 4 (range 2-7), APAC HE II score 10 (4-28), and C-nactive protein concentration 286 mg/L (79-469 ). Fifteen patients had pancreatic and/or peripancreatic necrosis. Eleven p atients developed severe organ failure, necessitating ventilatory support. Six developed multiple organ system failure, requiring inotropic support an d/or renal dialysis. There were four deaths (15.3%). Nine patients underwent early, and nine late, ERCP, respectively; six necro sectomy (5 proven infected necrosis, 1 continued deterioration despite maxi mal support) and 3 patients internal drainage of a pseudocyst. The feed was well-tolerated in 22 patients. In 3 patients gastric stasis pr oved troublesome. There was no evidence of clinical or biochemical deterior ation on commencing nasogastric feeding. Conclusion. It would appear that early NG feeding is usually possible in se vere acute pancreatitis. In most patients it appears safe, well-tolerated, and worthy of further study.