Total Enteral Nutrition in Prevention of Pancreatic Necrotic Infection in Severe Acute Pancreatitis

Objective: This study was designed to evaluate the effects of total enteral nutrition and total parenteral nutrition in prevention of pancreatic necrotic infection in severe acute pancreatitis. Methods: One hundred seven patients were enrolled in the study between 2003 and 2007. In the first week of hospitalization, they were randomized to feeding by either total parenteral nutrition (54 patients) or total enteral nutrition (53 patients). All patients were concomitantly administered with sufficient prophylactic antibiotics. Computed tomographic scan and C-reactive protein level indicated a similar clinical severity in both groups. Results: Eighty percent of the patients developed organ failure in the group with total parenteral nutrition, which was higher than that in the group with total enteral nutrition (21%). Eighty percent and 22% (P < 0.05) of the patients in the total parenteral nutrition and total enteral nutrition groups, respectively, underwent surgical intervention. The incidence of pancreatic septic necroses in the group with total enteral nutrition (23%) was lower than that in the group with total parenteral nutrition (72%, P < 0.05). Mortality in the total parenteral nutrition group (43%) was higher than in the total enteral nutrition group (11%, P < 0.05). Conclusion: Total enteral nutrition is better than total parenteral nutrition in the prevention of pancreatic necrotic infection in severe acute pancreatitis.