Published in Journal of UOEH
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Early nutrition support plays an important role in the management of acute pancreatitis. While there are randomised controlled trials of enteral and parenteral feeding for acute pancreatitis the sample sizes are often small, prompting the authors (Kusanaga et al, Kitakyushu, Japan) to investigate the efficacy of enteral nutrition in acute pancreatitis using a national database with significantly larger numbers.
The Diagnostic Procedure Combination (DPC) is a Japanese national database which during the period of the study (2014-2015) represented 1181 hospitals in Japan. The database holds detailed patient data including prognostic factor scores and computed tomography grades for patients with acute pancreatitis. They included patients who main diagnosis was acute pancreatitis and defined those who started enteral nutrition within 7 days of admission as the ‘early enteral nutrition’ (EEN) cohort and those who commended after day 7 were the ‘enteral nutrition’ (EN) cohort. The primary outcome was in-hospital mortality and secondary outcomes included length of hospital stay.
A total of 25 978 patients (32% female, mean age 61yrs) had eligible data, split into EEN (n18 036) and EN (n7942) cohorts. Looking at the rate of in-hospital mortality, they noted a 56% reduction when enteral nutrition was provided within 7 days (95% CI 0.358-0.551, p<0.001). When classified by disease severity, in those with ‘mild’ acute pancreatitis, there was a significant reduction of in-hospital mortality of 74% (95% CI 0.185-0.357, p<0.001) and in those with ‘severe’ acute pancreatitis there was a 50% reduction (95% CI 0.419-0.601, p<0.001) in those that received EEN. For length of hospital stay, there was a significant reduction of 8.6 days in those that received EEN (95% CI -9.05—8.13, p<0.001).
Acknowledging that this retrospective database design does have limitations such as the ability to interpret the results alongside other relevant clinical data that was not collected (e.g. treatment methods) the authors conclude that early enteral nutrition was independently associated with reduced in-hospital mortality and reduced length of hospital stay. It seems fair to conclude that early enteral nutrition should be considered a management tool for the treatment of patients with acute pancreatitis.