Total Enteral Nutrition Favored Over TPN in Acute Pancreatitis

Laurie Barclay, MD

May 21, 2002

NEW YORK (MedscapeWire) May 22 -- Although restricting oral intake has been a standard of care in acute pancreatitis, results of a randomized controlled trial presented on May 21 at the Digestive Disease Week may change that standard. Total enteral nutrition (TEN) was associated with a more rapid normalization of inflammatory markers, fewer complications, and lower costs than total parenteral nutrition (TPN).

"This study confirms that TEN or TPN may be used safely and provide adequate nutrition in severe pancreatitis," write Brian Louie and colleagues.

Of 548 consecutive patients with pancreatitis, those with a Ranson's score greater than 2 who did not tolerate clear fluids 4 days after admission were randomized to receive TPN (15 patients) or TEN (10 patients). In patients treated with TEN, C-reactive protein levels decreased by 50% 2.6 days faster than in patients treated with TPN ( P=.17). Three patients in the TPN group died, for an overall mortality rate of 8.3%. Three patients on TPN and 1 on TEN required surgery for infected pancreatic collections. Complications of feeding were minor in each group.

Average costs were $1207 per patient on TEN compared with $1968 per patient on TPN ( P=.24). After sensitivity analysis, the average cost of TEN was $1012 compared with $1968 for TPN ( P=.04).

"It appears that TEN is associated with faster attenuation of inflammation, with fewer septic complications, and is the preferred therapy in terms of cost-effectiveness," the authors write. "This study favors TEN for nutritional support in severe pancreatitis."

DDW Annual Meeting: Abstract 100213. May 21, 2002.

Reviewed by Gary D. Vogin, MD

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