Abstract
Early enteral nutrition is recommended as first-line nutritional management in patients with severe acute pancreatitis because it decreases the incidence of infection and mortality. However, it is not common in Japan. In this prospective multicenter study, we analyzed the current status of nutritional management in a series of patients with severe acute pancreatitis and highlighted the problems involved. This study enrolled 43 patients under the protocol to implement early enteral nutrition, aged 56.5±2.4 years who were admitted to 8 facilities 1.4±0.2 days after symptom onset between January 2009 and March 2011. The patients had a prognostic score of 4.0±0.2 and an APACHE II score of 13.7±1.3. Enteral nutrition was given to 30 (69.8%) patients according to the preset criteria for initiation of enteral nutrition, with only 4 (9.3%) of them receiving it within 48 h after admission (early enteral nutrition), showing that the median time from admission to initiation of enteral nutrition was 5.5 days. The reason for the delay in the initiation of enteral nutrition was, most frequently, elevated levels of pancreatic enzymes. In addition, conditions that made enteral nutrition difficult to initiate and that accounted for 51% of patients included ileus symptoms (22%) and circulatory insufficiency (12%). Enteral nutrition was discontinued in 3 (10%) patients because of severe diarrhea, pseudomembranous enterocolitis, or ileus symptoms, respectively, resulting in prolonged hospital stay (p=0.02) compared to other patients. There were no significant differences in either absolute levels (p>0.05) or time course changes in serum amylase levels (p=0.64) during the first 7 hospital days between patients with early enteral nutrition (n=4) and those who did not receive enteral nutrition within 7 hospital days (n=22); in general, serum amylase levels tended to decrease in both groups. There was also no intergroup difference in the level of C-reactive protein (p>0.05, p=0.97). No significant differences were found in the transition to operative treatment, infectious complications, days of intensive care unit stay, or days of hospital stay among 3 groups of patients, i.e., those who received early enteral nutrition, those who received enteral nutrition within 7 hospital days, and those who did not receive enteral nutrition within 7 hospital days. The results suggest that initiation of early enteral nutrition should be decided judiciously in about half of the patients with severe acute pancreatitis.
