Enteral Nutrition within 48 Hours of Admission Improves Clinical Outcomes of Acute Pancreatitis by Reducing Complications: A Meta-Analysis

Li, Jieyao; Yu, Tao; Chen, Guangcheng; Yuan, Yuhong; Wu, Zhong; Zhao, Lei; Chen, Qi‐Kui

doi:10.1371/journal.pone.0064926

Cited by 95 publications

(66 citation statements)

References 39 publications

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“…In a recent meta analysis, patients receiving early initiation of enteral nutrition (defined as within 48 h of admission) had significantly lower rates of infectious complications (OR = 0.45, 95%CI: 0.150.77, P < 0.05), organ failure (OR = 0.27, 95%CI: 0.14-0.50, P < 0.05), length of hospitalization [mean difference 2.18 d, 95%CI: (3.48)(0.87), P < 0.05], and mortality (OR = 0.31, 95%CI: 0.140.71, P < 0.05) compared to those with delayed enteral nutrition or TPN [11] . However, the exact time at whichenteral feeding should be initiated is not yet established.…”

Section: Early Vs Late Enteral Feedingmentioning

confidence: 99%

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Management of pancreatic fluid collections: A comprehensive review of the literature

Tyberg¹,

Karia²,

Gabr³

et al. 2016

WJG

158

143

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Pancreatic fluid collections (PFCs) are a frequent complication of pancreatitis. It is important to classify PFCs to guide management. The revised Atlanta criteria classifies PFCs as acute or chronic, with chronic fluid collections subdivided into pseudocysts and walled-off pancreatic necrosis (WOPN). Establishing adequate nutritional support is an essential step in the management of PFCs. Early attempts at oral feeding can be trialed in patients with mild pancreatitis. Enteral feeding should be implemented in patients with moderate to severe pancreatitis. Jejunal feeding remains the preferred route of enteral nutrition. Symptomatic PFCs require drainage; options include surgical, percutaneous, or endoscopic approaches. With the advent of newer and more advanced endoscopic tools and expertise, and an associated reduction in health care costs, minimally invasive endoscopic drainage has become the preferable approach. An endoscopic ultrasonography-guided approach using a seldinger technique is the preferred endoscopic approach. Both plastic stents and metal stents are efficacious and safe; however, metal stents may offer an advantage, especially in infected pseudocysts and in WOPN. Direct endoscopic necrosectomy is often required in WOPN. Lumen apposing metal stents that allow for direct endoscopic necrosectomy and debridement through the stent lumen are preferred in these patients. Endoscopic retrograde cholangio pancreatography with pancreatic duct (PD) exploration should be performed concurrent to PFC drainage. PD disruption is associated with an increased severity of pancreatitis, an increased risk of recurrent attacks of pancreatitis and long-term complications, and a decreased rate of PFC resolution after drainage. Any pancreatic ductal disruption should be bridged with endoscopic stenting. However, with improving pathophysiologic under standing and improving diagnostic tools, it became clear that a more detailed organizational system was required. More specifically, one that distinguished between collections containing fluid alone vs those arising from necrosis and/or containing solid components. As such, a new classification system was developed known as the revised Atlanta criteria [4] . Similar to the original Atlanta Criteria, PFCs are classified as acute (< 4 wk after the pancreatitis episode) or chronic (> 4 wk after the pancreatitis episode). However, in the revised criteria, both acute and chronic collections are further subdivided based on the presence of necrosis within the collection. Acute collections are divided into: acute peripancreatic fluid collections (APFC) and acute necrotic collections (ANC); chronic fluid collections are divided into: pseudocysts or walledoff pancreatic necrosis (WOPN). These new classifications are important because the treatment and management varies depending on the type of collection. ENTERAL FEEDINGThe first step in the management of any PFC is ensuring adequate nutritional support. In mild to moderate acute pancreatitis, oral feeding can be initiated when...

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Section: Early Vs Late Enteral Feedingmentioning

confidence: 99%

“…Surgical cystogastrostomy involves an open or laparoscopic procedure in which an anastomosis is created between the lumen of the cyst cavity and the stomach or small bowel using suturing or stapling devices [11] . Depending on the location, a cystojejunostomy can also be a surgical alternative.…”

Section: Surgical Drainagementioning

confidence: 99%

Management of pancreatic fluid collections: A comprehensive review of the literature

Tyberg¹,

Karia²,

Gabr³

et al. 2016

WJG

158

143

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“…Enteral feeding is hypothesized to maintain the integrity of the gastrointestinal mucosal barrier, thus inhibiting bacterial translocation and reducing infectious complications. Several non‐randomized studies concluded that very early enteral feeding (within 24–48 h after onset) reduces pancreatic infections and multiple organ failure even further. The results are awaited from a multicentre trial investigating the effect of very early enteral feeding in patients with predicted severe pancreatitis.…”

Section: Management During the First Weekmentioning

confidence: 99%

Staged multidisciplinary step-up management for necrotizing pancreatitis

Costa

Boerma

Santvoort

et al. 2013

British Journal of Surgery

153

144

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Background: Some 15 per cent of all patients with acute pancreatitis develop necrotizing pancreatitis, with potentially significant consequences for both patients and healthcare services. Conclusion: Outcome following necrotizing pancreatitis has improved substantially in recent years as a result of a shift from early surgical debridement to a staged, minimally invasive, multidisciplinary, step-up approach.

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“…A meta-analysis of randomized trials involving acutely ill patients, but no pancreatitis, showed a 22% reduction in the rate of major infections when nasoenteric tube feeding was started ≤36 h as compared with a later start [23]. In patients with AP, nonrandomized studies have shown that nasoenteric tube feeding started within 48 h after admission, as compared with a start after 48 h, significantly reduced the rate of major infection and in some studies even reduced mortality [24,25,26,27]. Importantly, the use of an enteric feeding tube not only has presumed benefits.…”

Section: Feeding In Pancreatitismentioning

confidence: 99%

Improving the Outcome of Acute Pancreatitis

Bruno

2016

Dig Dis

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Acute pancreatitis (AP) is the most common indication for hospital admission and its incidence is rising. It has a variable prognosis, which is mainly dependent upon the development of persistent organ failure and infected necrotizing pancreatitis. In the past few years, based on large-scale multicenter randomized trials, some novel insights regarding clinical management have emerged. In patients with infected pancreatic necrosis, a step-up approach of percutaneous catheter drainage followed by necrosectomy only when the patient does not improve, reduces new-onset organ failure and prevents the need for necrosectomy in about a third of patients. A randomized pilot study comparing surgical to endoscopic necrosectomy in patients with infected necrotizing pancreatitis showed a striking reduction of the pro-inflammatory response following endoscopic necrosectomy. These promising results have recently been tested in a large multicenter randomized trial whose results are eagerly awaited. Contrary to earlier data from uncontrolled studies, a large multicenter randomized trial comparing early (within 24 h) nasoenteric tube feeding compared with an oral diet after 72 h, did not show that early nasoenteric tube feeding was superior in reducing the rate of infection or death in patients with AP at high risk for complications. Although early ERCP does not have a role in the treatment of predicted mild pancreatitis, except in the case of concomitant cholangitis, it may ameliorate the disease course in patients with predicted severe pancreatitis. Currently, a large-scale randomized study is underway and results are expected in 2017.

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Enteral Nutrition within 48 Hours of Admission Improves Clinical Outcomes of Acute Pancreatitis by Reducing Complications: A Meta-Analysis

Cited by 95 publications

References 39 publications

Management of pancreatic fluid collections: A comprehensive review of the literature

Management of pancreatic fluid collections: A comprehensive review of the literature

Staged multidisciplinary step-up management for necrotizing pancreatitis

Improving the Outcome of Acute Pancreatitis

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