Early nasogastric tube feeding vs. NPO approach for mild-moderate acute pancreatitis.

By: Raveen Chawla.

Traditionally, when it comes to managing mild-to-moderate acute pancreatitis, nil per os (NPO) approach is used most widely. The concept of “pancreas rest” has been broadly advocated in spite of never being proven in a randomized clinical trial. Keeping the same principal in mind, nasojejunal tube feeding approach was introduced which was also proven to be safe and efficient.  The shift in paradigm started to take place a few years ago when nasogastric tube (NGT) feeding was proven to be just as safe and efficient as nasojejunal tube feeding. Now, a randomized controlled trial conducted at the University of Auckland compared NGT feeding approach versus NPO approach in the management of mild-to-moderate acute pancreatitis.   

In this study, 17 patients were randomly allocated to the NGT group and 18 to the NPO group. Primary endpoint that was being measured was the total length of hospital stay, and the secondary endpoints were presence of oral food intolerance, opiate requirements, and change in pain intensity. The study did not find any significant results regarding the primary endpoint. The overall hospital stay in the NGT group was 9 days versus 8.5 days in the NPO group with a p-value of 0.91. However, there were significant findings for secondary endpoints. Among the 17 patients in the NGT group, only one patient had oral food intolerance after 4 days; as opposed to 9 out of 18 patients in NPO group (p=.004). The number of patients not requiring opiates at 48 h after randomization in NGT group was 9/17 as opposed to 3/18 in NPO group (p=.024). Finally, decrease in pain levels were significantly greater among NGT patients than NPO patients. [1]

Based on the results, authors concluded that a NGT placed within 24 hours of hospital admission is well tolerated in patients with mild-to-moderate acute pancreatitis. Additionally, when compared to NPO group, NGT feeding also improves the intensity of pain, need for opiates, and risk for food intolerance. It is worth noticing that the sample size was quite small. This article challenges the norm of keeping patients NPO for acute pancreatitis. Similar studies with larger sample size may be needed before following this approach for the management of acute pancreatitis.

Disclaimer:  Please note that the information above has been obtained from multiple sources for the sole purpose of student education and should not be used in the direct care of patients and/or clinical decision making.

Reference:

1) Petrov M.S., McIlroy K., Grayson L., Phillips A.R.J., Windsor J.A. Early nasogastric tube feeding versus nil per os in mild to moderate acute pancreatitis: A randomized controlled trial. (2013)  Clinical Nutrition.

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