Abstracts
1999 Digestive Disease Week

# 2148 PHASE II RANDOMISED CONTROLLED TRIAL OF EARLY ENTERAL NUTRITION IN PREDICTED SEVERE ACUTE PANCREATITIS
James J Powell, Gordon Hill, Sian Storey Miss, John Murchison, Kenneth CH Fearon Mr, Royal Infirmary of Edinburgh, Edinburgh United Kingdom; James A Ross, Univ of Edinburgh, Edinburgh United Kingdom; Ajith K Siriwardena Mr, Royal Infirmary of Edinburgh, Edinburgh United Kingdom

Intro Enteral nutrition (EN) in critically ill patients improves outcome by mechanisms which are thought to involve modulation of the inflammatory response through amelioration of intestinal dysfunction. Because conventional therapy in acute pancreatitis involves an initial period of fasting this study tests the hypothesis that EN in severe acute pancreatitis will improve outcome through similar mechanisms. Methods Randomised controlled trial of early EN versus conventional therapy in prognostically severe (Glasgow ³3 or APACHE II ³7) acute pancreatitis. Primary outcome measures were i) tolerance of EN ii) intestinal dysfunction iii) change in inflammatory markers iv) organ dysfunction score (ODS). The study period was to day 10 post admission or introduction of diet. EN was delivered through a nasojejunal tube. Stated values are median (IQR). Appropriate statistical tests were used. Results 27 patients were randomised; 13 of whom received EN. Because the median duration to introduction of diet was 5.5 days (5-6.5), results presented relate to the first 4 days of admission. i)Tube dislodgement episodes were common. Median caloric intake was 20% (11-44) of nutritional requirements. ii)At day 4, patients receiving enteral nutrition had significantly worse intestinal function (p=.026). iii)The introduction of EN had no significant effect on serum anti-endotoxin core antibody (p=.99), serum interleukin 6 (p=.28), serum soluble tumour necrosis factor receptor I (p=.53) and serum C-reactive protein (p=.62) levels. iv)The median ODS was 0.5 (0-2). There was no significant difference in ODS between the two groups (p=.52). Conclusion This study shows no evidence of improved outcome in patients receiving EN compared to conventional therapy. These findings contradict the results of earlier trials of EN in acute pancreatitis.

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