Brief Article
Copyright ©2010 Baishideng. All rights reserved.
World J Gastroenterol. Aug 7, 2010; 16(29): 3692-3696
Published online Aug 7, 2010. doi: 10.3748/wjg.v16.i29.3692
Nasogastric or nasointestinal feeding in severe acute pancreatitis
Matteo Piciucchi, Elettra Merola, Massimo Marignani, Marianna Signoretti, Roberto Valente, Lucia Cocomello, Flavia Baccini, Francesco Panzuto, Gabriele Capurso, Gianfranco Delle Fave
Matteo Piciucchi, Elettra Merola, Massimo Marignani, Marianna Signoretti, Roberto Valente, Lucia Cocomello, Flavia Baccini, Francesco Panzuto, Gabriele Capurso, Gianfranco Delle Fave, Digestive and Liver Disease Unit, II Medical School, University “Sapienza”, 00189 Rome, Italy
Author contributions: Capurso G and Delle Fave G designed the research; Piciucchi M, Merola E, Marignani M, Signoretti M, Valente R, Cocomello L, Baccini F and Panzuto F contributed to data acquisition and drafting; Piciucchi M, Merola E and Capurso G wrote the paper; all authors revised the paper and approved the final version.
Correspondence to: Gianfranco Delle Fave, Professor, Digestive and Liver Disease Unit, II Medical School, University “Sapienza”, S. Andrea Hospital, Via Di Grottarossa 1035, 00189 Rome, Italy. gianfranco.dellefave@uniroma1.it
Telephone: +39-6-33775691 Fax: +39-6-33775526
Received: February 23, 2010
Revised: May 14, 2010
Accepted: May 21, 2010
Published online: August 7, 2010
Abstract

AIM: To assess the rate of spontaneous tube migration and to compare the effects of naso-gastric and naso-intestinal (NI) (beyond the ligament of Treitz) feeding in severe acute pancreatitis (SAP).

METHODS: After bedside intragastric insertion, tube position was assessed, and enteral nutrition (EN) started at day 4, irrespective of tube localization. Patients were monitored daily and clinical and laboratory parameters evaluated to compare the outcome of patients with nasogastric (NG) or NI tube.

RESULTS: Spontaneous tube migration to a NI site occurred in 10/25 (40%) prospectively enrolled SAP patients, while in 15 (60%) nutrition was started with a NG tube. Groups were similar for demographics and pancreatitis aetiology but computed tomography (CT) severity index was higher in NG tube patients than in NI (mean 6.2 vs 4.7, P = 0.04). The CT index seemed a risk factor for failed obtainment of spontaneous distal migration. EN trough NG or NI tube were similar in terms of tolerability, safety, clinical goals, complications and hospital stay.

CONCLUSION: Spontaneous distal tube migration is successful in 40% of SAP patients, with higher CT severity index predicting intragastric retention; in such cases EN by NG tubes seems to provide a pragmatic alternative opportunity with similar outcomes.

Keywords: Acute pancreatitis; Enteral feeding; Tube migration; Nasogastric; Safety