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Early tube feeding not superior to oral diet in acute pancreatitis
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Early nasoenteric tube feeding was not superior to oral diet in reducing infection or morality rate in patients with acute pancreatitis who had high risk for complications, according to new research data.
“In our study, we found that, despite the positive effects reported in earlier studies, early tube feeding does not reduce major infections in patients with acute pancreatitis,” Olaf J. Bakker, MD, from the Dutch Pancreatitis Study Group and the department of surgery at University Medical Center Utrecht, the Netherlands, told Healio Gastroenterology. “Furthermore, in the control group, only 30% of patients needed a feeding tube; in other words, 70% of patients were able to eat a normal diet.”
Olaf J. Bakker
From August 2008 to June 2012, Bakker and colleagues conducted the PYTHON trial to compare the effects of nasoenteric tube feeding vs. oral diet in acute pancreatitis patients at high risk for complications. A total of 208 patients from 19 Dutch hospitals were included in the intention-to-treat analysis. All participants had acute pancreatitis and were determined to be at high risk for complications based on serum C-reactive protein levels and modified Glasgow or APACHE II scores.
Patients were randomly assigned to nasoenteric tube feeding within 24 hours after presentation to the ED (n=101) or oral diet within 72 hours (n=104) with tube feeding provided only if patients had insufficient oral intake. Major infection (infected pancreatic necrosis, bacteremia or pneumonia) or death within 6 months occurred in 30% of the experimental group compared with 27% of the control group (RR=1.07; 95% CI, 0.79-1.44). Major infections occurred in 25% of the experimental group compared with 26% of controls (P=.087), and death, mostly related to persistent multiple organ failure, occurred in 11% vs. 7% (P=.33). Finally, among controls, only 31% required nasoenteric tube feeding due to poor tolerance of oral diet.
“As a result [of these data], future guidelines will recommend tube feeding only in case of insufficient intake. A feeding tube often causes considerable discomfort and needs to be replaced frequently,” Bakker said. “Our trial findings result in substantial avoidance of discomfort and costs.” – by Adam Leitenberger
Disclosure: See the study for a full list of researchers’ financial disclosures.
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