- Early EN is now standard of care in patients with acute pancreatitis
- Recent research suggests improved outcomes compared with previous strategies of pancreatic rest with TPN
- Guidance recommends commencing within 72 hours if intolerant of oral intake
- Enteral nutrition in acute pancreatitis can be administered via either the nasojejunal or nasogastric route:
- Many recommend early NJ feeding and supported by ESPEN guidance
- Two trials have also found no difference in outcomes in patients fed gastrically versus jejunally
- Nasogastric usually successful in 80% of patients
- Nasojejunal feeding should be used if intra-abdominal pressures are >15mmHg
- Parenteral nutrition can be administered in acute pancreatitis as second-line therapy if nasojejunal tube feeding is not tolerated (pain, ileus, nausea)
(NICE & ESPEN Guidelines)
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Advantages of enteral nutrition include:
- Cheaper
- Avoids need for central line
- Safer – associated with fewer complications
- Better outcome overall
- Maintains intestinal mucosal barrier
- Prevents bacterial translocation