Application of Early Enteral Nutrition on Treatment of Severe Acute Pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DONG Liang , KANG Yan

Intensive Care Unit, West China Hospital, Sichuan University, Chengdu 610041, ChinaCorresponding Author: KANG Yan， E-mail: kangyan@medmail.com.cn;

Corresponding author：

Keywords：

Severe acute pancreatitis; Early enteral nutrition; Complication

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Objective 　To discuss the feasibility and safety of early enteral nutrition (EN) on treatment of severe acute pancreatitis (SAP) and its influence.
Methods 　The advancement about application of early EN on treatment of SAP in recent years were reviewed.
Results 　In patients with SAP, early EN via catheter placed in the jejunum could protect the integrity of intestinal barrier and reduce infectious complications. But no consensus had been reached about the starting time, ingredient and infusion mode yet.
Conclusion 　Early EN may have positive effects on treatment of SAP, but further researches are still needed.

Citation： DONG Liang,KANG Yan. Application of Early Enteral Nutrition on Treatment of Severe Acute Pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2008, 15(8): 567-571. doi: Copy

1.	Kotani J, Usami M, Nomura H, et al. Enteral nutrition prevents bacterial translocation but does not improve survival during acute pancreatitis [J]. Arch Surg， 1999; 134(3)∶287.
2.	Windsor AC, Kanwar S, Li AG, et al. Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis [J]. Gut, 1998; 42(3)∶431.
3.	Powell JJ, Murchison JT, Fearon KC, et al. Randomized controlled trial of the effect of early enteral nutrition on markers of the inflammatory response in predicted severe acute pancreatitis [J]. Br J Surg, 2000; 87(10)∶1375.
4.	Eckerwall GE, Axelsson JB, Andersson RG. Early nasogastric feeding in predicted severe acute pancreatitis: A clinical, randomized study [J]. Ann Surg, 2006; 244(6)∶959.
5.	Kumar A, Singh N, Prakash S, et al. Early enteral nutrition in severe acute pancreatitis: a prospective randomized controlled trial comparing nasojejunal and nasogastric routes [J]. J Clin Gastroenterol, 2006; 40(5)∶431.
6.	李维勤，黎介寿. 重症急性胰腺炎患者的阶段性营养支持策略 [J]. 江苏临床医学杂志， 2002; 6（2）∶96.
7.	Heinrich S, Schfer M, Rousson V, et al. Evidence-based treatment of acute pancreatitis: a look at established paradigms [J]. Ann Surg, 2006; 243(2)∶154.
8.	Tellado JM. Prevention of infection following severe acute pancreatitis [J]. Curr Opin Crit Care, 2007; 13(4)∶416.
9.	李宁，黎介寿. 外科营养近20年的进展与展望 [J]. 中国实用外科杂志， 2002； 22（1）∶6.
10.	秦环龙，苏振东，胡雷光，等. 早期肠内营养对犬重症急性胰腺炎自然病程和肠道屏障功能的影响 [J]. 中国普外基础与临床杂志， 2002； 9（5）∶325.
11.	Casas M, Mora J, Fort E, et al. Total enteral nutrition vs. total parenteral nutrition in patients with severe acute pancreatitis [J]. Rev Esp Enferm Dig, 2007; 99(5)∶264.
12.	Jiang K, Chen XZ, Xia Q, et al. Early nasogastric enteral nutrition for severe acute pancreatitis: a systematic review [J]. World J Gastroenterol, 2007; 13(39)∶5253.
13.	秦环龙. 肠外与肠内营养对胰腺外分泌和急性重症胰腺炎的影响 [J]. 肠外与肠内营养, 2001; 8(4)∶240.
14.	Kalfarentzos F, Kehagias J, Mead N, et al. Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial [J]. Br J Surg, 1997; 84(12)∶1665.
15.	Wittmann T, Róka R, Palágyi P, et al. Continuous enteral feeding has an attenuating effect on the exocrine pancreas in rats [J]. Pancreas, 2001; 23(3)∶329.
16.	Hamvas J, Schwab R, Pap A. Jejunal feeding in necrotising acute pancreatitis—a retrospective study [J]. Acta Chir Hung, 1999; 38(2)∶177.
17.	王兴鹏. 重症急性胰腺炎患者实施早期肠内营养的可能性及其理论基础 [J]. 胰腺病学， 2002； 2（3）∶171.
18.	刘晓臣, 彭燕. 肠屏障功能障碍与重症急性胰腺炎 [J]. 世界华人消化杂志, 2006; 14(32)∶3131.
19.	Gupta R, Patel K, Calder PC, et al. A randomised clinical trial to assess the effect of total enteral and total parenteral nutritional support on metabolic, inflammatory and oxidative markers in patients with predicted severe acute pancreatitis (APACHE Ⅱ ＞or=6) [J]. Pancreatology, 2003; 3(5)∶406.
20.	Kudsk KA, Li J, Renegar KB. Loss of upper respiratory tract immunity with parenteral feeding [J]. Ann Surg, 1996; 223(6)∶629.
21.	Janu P, Li J, Renegar KB, et al. Recovery of gut-associated lymphoid tissue and upper respiratory tract immunity after parenteral nutrition [J]. Ann Surg， 1997; 225(6)∶707.
22.	King BK, Li J, Kudsk KA. A temporal study of TPN-induced changes in gut-associated lymphoid tissue and mucosal immunity [J]. Arch Surg， 1997; 132(12)∶1303.
23.	Li J, Kudsk KA, Gocinski B, et al. Effets of parenteral and enteral nutrition on gut-associated lymphoid tissue [J]. J Trauma， 1995; 39(1)∶44.
24.	Qin HL, Su ZD, Hu LG, et al. Effect of early intrajejunal nutrition on pancreatic pathological features and gut barrier function in dogs with acute pancreatitis [J]. Clin Nutr, 2002; 21(6)∶469.
25.	O’Dwyer ST, Michie HR, Ziegler TR, et al. A single dose of endotoxin increases intestinal permeability in healthy humans [J]. Arch Surg, 1988; 123(12)∶1459.
26.	万献尧, 于凯江, 马晓春, 等. 中国重症加强治疗病房危重患者营养支持指导意见(2006) [J]. 中华外科杂志, 2006; 44(17)∶1167.
27.	Cassim MM, Allardyce DB. Pancreatic secretion in response to jejunal feeding of elemental diet [J]. Ann Surg, 1974; 180(2)∶228.
28.	Vu MK, van der Veek PP, Frlich M, et al. Does jejunal feeding activate exocrine pancreatic secretion? [J]. Eur J Clin Invest, 1999; 29(12)∶1053.
29.	Abou-Assi S, Craig K, OKeefe SJ. Hypocaloric jejunal feeding is better than total parenteral nutrition in acute pancreatitis: results of a randomized comparative study [J]. Am J Gastroenterol, 2002; 97(9)∶2255.
30.	Ragins H, Levenson SM, Signer R, et al. Intrajejunal administration of an elemental diet at neutral pH avoids pancreatic stimulation. Studies in dog and man [J]. Am J Surg, 1973; 126(5)∶606.
31.	Marik PE, Zaloga GP. Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis [J]. BMJ, 2004; 328(7453)∶1407.
32.	Erstad BL. Enteral nutrition support in acute pancreatitis [J]. Ann Pharmacother, 2000; 34(4)∶514.
33.	Kale-Pradhan PB, Elnabtity MH, Park NJ, et al. Enteral nutrition in patients with pancreatitis [J]. Pharmacotherapy, 1999; 19(9)∶1036.
34.	Karakan T, Ergun M, Dogan I, et al. Comparison of early enteral nutrition in severe acute pancreatitis with prebiotic fiber supplementation versus standard enteral solution: a prospective randomized double-blind study [J]. World J Gastroenterol, 2007; 13(19)∶2733.
35.	van Berge Henegouwen MI, Akkermans LM, van Gulik TM, et al. Prospective, randomized trial on the effect of cyclic versus continuous enteral nutrition on postoperative gastric function after pylorus-preserving pancreatoduodenectomy [J]. Ann Surg, 1997; 226(6)∶677.
36.	Dickerson RN, Vehe KL, Mullen JL, et al. Resting energy expenditure in patients with pancreatitis [J]. Crit Care Med, 1991; 19(4)∶484.
37.	Lobo DN, Memon MA, Allison SP, et al. Evolution of nutritional support in acute pancreatitis [J]. Br J Surg, 2000; 87(6)∶695.
38.	Petrov MS, Kukosh MV, Emelyanov NV. A randomized controlled trial of enteral versus parenteral feeding in patients with predicted severe acute pancreatitis shows a significant reduction in mortality and in infected pancreatic complications with total enteral nutrition [J]. Dig Surg, 2006; 23(5-6)∶336.
39.	Oláh A, Belágyi T, Issekutz A, et al. Combination of early nasojejunal feeding with modern synbiotic therapy in the treatment of severe acute pancreatitis (prospective, randomized, double-blind study) [J]. Magy Seb, 2005; 58(3)∶173.
40.	吴在德, 吴肇汉主编. 外科学 [M]. 第6版. 北京: 人民卫生出版社， 2004∶148～150.
41.	吴丹，娄健颖，林汉庭. 急性胰腺炎的肠内营养 [J]. 中国实用外科杂志， 2003; 2（23）∶70.
42.	Nakad A, Piessevaux H, Marot JC, et al. Is early enteral nutrition in acute pancreatitis dangerous? About 20 patients fed by an endoscopically placed nasogastrojejunal tube [J]. Pancreas, 1998; 17(2)∶187.
43.	刘俊，夏强. 急性重症胰腺炎早期肠内营养反复失败1例 [J]. 肠内与肠外营养， 2002； 9（2）∶118.
44.	伍晓汀，张肇达，赵小菲. 重症急性胰腺炎的营养支持 [J]. 中国普外基础与临床杂志， 2004； 11（3）∶273.
45.	Whitcomb DC. Clinical practice. Acute pancreatitis [J]. N Engl J Med, 2006; 354(20)∶2142.

1. 　Kotani J, Usami M, Nomura H, et al. Enteral nutrition prevents bacterial translocation but does not improve survival during acute pancreatitis [J]. Arch Surg， 1999; 134(3)∶287.
2. 　Windsor AC, Kanwar S, Li AG, et al. Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis [J]. Gut, 1998; 42(3)∶431.
3. 　Powell JJ, Murchison JT, Fearon KC, et al. Randomized controlled trial of the effect of early enteral nutrition on markers of the inflammatory response in predicted severe acute pancreatitis [J]. Br J Surg, 2000; 87(10)∶1375.
4. 　Eckerwall GE, Axelsson JB, Andersson RG. Early nasogastric feeding in predicted severe acute pancreatitis: A clinical, randomized study [J]. Ann Surg, 2006; 244(6)∶959.
5. 　Kumar A, Singh N, Prakash S, et al. Early enteral nutrition in severe acute pancreatitis: a prospective randomized controlled trial comparing nasojejunal and nasogastric routes [J]. J Clin Gastroenterol, 2006; 40(5)∶431.
6. 　李维勤，黎介寿. 重症急性胰腺炎患者的阶段性营养支持策略 [J]. 江苏临床医学杂志， 2002; 6（2）∶96.
7. 　Heinrich S, Schfer M, Rousson V, et al. Evidence-based treatment of acute pancreatitis: a look at established paradigms [J]. Ann Surg, 2006; 243(2)∶154.
8. 　Tellado JM. Prevention of infection following severe acute pancreatitis [J]. Curr Opin Crit Care, 2007; 13(4)∶416.
9. 　李宁，黎介寿. 外科营养近20年的进展与展望 [J]. 中国实用外科杂志， 2002； 22（1）∶6.
10. 　秦环龙，苏振东，胡雷光，等. 早期肠内营养对犬重症急性胰腺炎自然病程和肠道屏障功能的影响 [J]. 中国普外基础与临床杂志， 2002； 9（5）∶325.
11. 　Casas M, Mora J, Fort E, et al. Total enteral nutrition vs. total parenteral nutrition in patients with severe acute pancreatitis [J]. Rev Esp Enferm Dig, 2007; 99(5)∶264.
12. 　 Jiang K, Chen XZ, Xia Q, et al. Early nasogastric enteral nutrition for severe acute pancreatitis: a systematic review [J]. World J Gastroenterol, 2007; 13(39)∶5253.
13. 　秦环龙. 肠外与肠内营养对胰腺外分泌和急性重症胰腺炎的影响 [J]. 肠外与肠内营养, 2001; 8(4)∶240.
14. 　Kalfarentzos F, Kehagias J, Mead N, et al. Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial [J]. Br J Surg, 1997; 84(12)∶1665.
15. 　Wittmann T, Róka R, Palágyi P, et al. Continuous enteral feeding has an attenuating effect on the exocrine pancreas in rats [J]. Pancreas, 2001; 23(3)∶329.
16. 　Hamvas J, Schwab R, Pap A. Jejunal feeding in necrotising acute pancreatitis—a retrospective study [J]. Acta Chir Hung, 1999; 38(2)∶177.
17. 　王兴鹏. 重症急性胰腺炎患者实施早期肠内营养的可能性及其理论基础 [J]. 胰腺病学， 2002； 2（3）∶171.
18. 　刘晓臣, 彭燕. 肠屏障功能障碍与重症急性胰腺炎 [J]. 世界华人消化杂志, 2006; 14(32)∶3131.
19. 　Gupta R, Patel K, Calder PC, et al. A randomised clinical trial to assess the effect of total enteral and total parenteral nutritional support on metabolic, inflammatory and oxidative markers in patients with predicted severe acute pancreatitis (APACHE Ⅱ ＞or=6) [J]. Pancreatology, 2003; 3(5)∶406.
20. 　Kudsk KA, Li J, Renegar KB. Loss of upper respiratory tract immunity with parenteral feeding [J]. Ann Surg, 1996; 223(6)∶629.
21. 　Janu P, Li J, Renegar KB, et al. Recovery of gut-associated lymphoid tissue and upper respiratory tract immunity after parenteral nutrition [J]. Ann Surg， 1997; 225(6)∶707.
22. 　King BK, Li J, Kudsk KA. A temporal study of TPN-induced changes in gut-associated lymphoid tissue and mucosal immunity [J]. Arch Surg， 1997; 132(12)∶1303.
23. 　Li J, Kudsk KA, Gocinski B, et al. Effets of parenteral and enteral nutrition on gut-associated lymphoid tissue [J]. J Trauma， 1995; 39(1)∶44.
24. 　Qin HL, Su ZD, Hu LG, et al. Effect of early intrajejunal nutrition on pancreatic pathological features and gut barrier function in dogs with acute pancreatitis [J]. Clin Nutr, 2002; 21(6)∶469.
25. 　O’Dwyer ST, Michie HR, Ziegler TR, et al. A single dose of endotoxin increases intestinal permeability in healthy humans [J]. Arch Surg, 1988; 123(12)∶1459.
26. 　万献尧, 于凯江, 马晓春, 等. 中国重症加强治疗病房危重患者营养支持指导意见(2006) [J]. 中华外科杂志, 2006; 44(17)∶1167.
27. 　Cassim MM, Allardyce DB. Pancreatic secretion in response to jejunal feeding of elemental diet [J]. Ann Surg, 1974; 180(2)∶228.
28. 　Vu MK, van der Veek PP, Frlich M, et al. Does jejunal feeding activate exocrine pancreatic secretion? [J]. Eur J Clin Invest, 1999; 29(12)∶1053.
29. 　Abou-Assi S, Craig K, OKeefe SJ. Hypocaloric jejunal feeding is better than total parenteral nutrition in acute pancreatitis: results of a randomized comparative study [J]. Am J Gastroenterol, 2002; 97(9)∶2255.
30. 　Ragins H, Levenson SM, Signer R, et al. Intrajejunal administration of an elemental diet at neutral pH avoids pancreatic stimulation. Studies in dog and man [J]. Am J Surg, 1973; 126(5)∶606.
31. 　Marik PE, Zaloga GP. Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis [J]. BMJ, 2004; 328(7453)∶1407.
32. 　Erstad BL. Enteral nutrition support in acute pancreatitis [J]. Ann Pharmacother, 2000; 34(4)∶514.
33. 　Kale-Pradhan PB, Elnabtity MH, Park NJ, et al. Enteral nutrition in patients with pancreatitis [J]. Pharmacotherapy, 1999; 19(9)∶1036.
34. 　Karakan T, Ergun M, Dogan I, et al. Comparison of early enteral nutrition in severe acute pancreatitis with prebiotic fiber supplementation versus standard enteral solution: a prospective randomized double-blind study [J]. World J Gastroenterol, 2007; 13(19)∶2733.
35. 　van Berge Henegouwen MI, Akkermans LM, van Gulik TM, et al. Prospective, randomized trial on the effect of cyclic versus continuous enteral nutrition on postoperative gastric function after pylorus-preserving pancreatoduodenectomy [J]. Ann Surg, 1997; 226(6)∶677.
36. 　Dickerson RN, Vehe KL, Mullen JL, et al. Resting energy expenditure in patients with pancreatitis [J]. Crit Care Med, 1991; 19(4)∶484.
37. 　Lobo DN, Memon MA, Allison SP, et al. Evolution of nutritional support in acute pancreatitis [J]. Br J Surg, 2000; 87(6)∶695.
38. 　Petrov MS, Kukosh MV, Emelyanov NV. A randomized controlled trial of enteral versus parenteral feeding in patients with predicted severe acute pancreatitis shows a significant reduction in mortality and in infected pancreatic complications with total enteral nutrition [J]. Dig Surg, 2006; 23(5-6)∶336.
39. 　Oláh A, Belágyi T, Issekutz A, et al. Combination of early nasojejunal feeding with modern synbiotic therapy in the treatment of severe acute pancreatitis (prospective, randomized, double-blind study) [J]. Magy Seb, 2005; 58(3)∶173.
40. 　吴在德, 吴肇汉主编. 外科学 [M]. 第6版. 北京: 人民卫生出版社， 2004∶148～150.
41. 　吴丹，娄健颖，林汉庭. 急性胰腺炎的肠内营养 [J]. 中国实用外科杂志， 2003; 2（23）∶70.
42. 　Nakad A, Piessevaux H, Marot JC, et al. Is early enteral nutrition in acute pancreatitis dangerous? About 20 patients fed by an endoscopically placed nasogastrojejunal tube [J]. Pancreas, 1998; 17(2)∶187.
43. 　刘俊，夏强. 急性重症胰腺炎早期肠内营养反复失败1例 [J]. 肠内与肠外营养， 2002； 9（2）∶118.
44. 　伍晓汀，张肇达，赵小菲. 重症急性胰腺炎的营养支持 [J]. 中国普外基础与临床杂志， 2004； 11（3）∶273.
45. 　Whitcomb DC. Clinical practice. Acute pancreatitis [J]. N Engl J Med, 2006; 354(20)∶2142.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of Early Enteral Nutrition on Treatment of Severe Acute Pancreatitis

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