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Clinical Outcome in Low Socioeconomic Patients with Severe Acute Pancreatitis Treated Either with Early Nasogastric Feeding Or Total Parenteral Nutrition-a Comparative Study
Santosh Kumar*, Vimal Bhandar, Hari G. Vyas
General Surgery, Safdarjung Hospital, New Delhi, India
Background: Severe Acute Pancreatitis (SAP) is common in north-east part of India and accounts for around 3, 13,256 hospital admissions per year mostly affecting low socioeconomic population. In SAP severity of inflammatory response together with increased intestinal permeability directly affects the clinical outcome. Enteral feeding has been suggested efficacious and safe to parenteral nutrition because of proposed beneficial effect on gut barrier. Our study was to compare early enteral feeding with Total parental nutrition (TPN) in view of clinical outcome.MATERIALS AND METHODS: 50 patients who meet the inclusion criteria were randomized either to TPN or Enteral nutrition (EN) groups. The nutritional regimen was started 24 hours from admission. The nutritional regime aimed to be isocaloric between 2 groups with the energy target of 25kcal/kg/day based on admission weight. The initial rate of enteral feed was 25kcal/hr and gradually increased daily up to 100kcal/hr. RESULTS: The incidence of infectious complications (8 vs. 16, p-value 0.024) was significantly lower in enterally fed group. The most significant infective complication was pancreatic infection (pancreatic necrosis & pancreatic abscess) [4 vs. 11, p=0.037] and central venous catheter infection (0 vs. 8, p=0.004). Systematic complication including multiorgan failure was also significantly lower in EN group (5 vs. 12, p=0.037). In enterally fed group only 1 patient expired compare to 4 in TPN patients. Incidence of Hyperglycemia was significantly higher in TPN group (3 vs. 14, p= 0.002). The mean hospital stay in EN group was 6.76 days as compared to TPN 10.4 days. The mean cost of feeding in TPN was approximately 11 times more than Enterally fed patients.CONCLUSION: The Enteral feed was well tolerated, cheaper and effective. It significantly reduces the incidence of infective complications and good control of blood glucose. EN is the better option in management of SAP among low socioeconomic population.
Table 1. Clinical Outcome of the study
| Out come | EN(n=25) | TPN(n=25) | P- value |
| Mortality | 1 | 4 | 0.349 |
| Infectious Complication | 8 | 16 | 0.024 |
| Non-Infectious Complication | 11 | 16 | 0.156 |
| Systemic Complication | 5 | 12 | 0.037 |
| Need for Surgery | 1 | 4 | 0.349 |
| Total cost(in Rs.) | 1268 | 13688 | - |
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