Enteral trumps total parenteral nutrition in pancreatic fistula treatment
MedWire News: Researchers report that enteral nutrition-based treatment of patients with postoperative pancreatic fistulae produces a higher fistula closure rate and shorter closure time than treatment with total parenteral nutrition (TPN).
"The higher costs of TPN along with its potential septic and metabolic disadvantages should persuade clinicians to consider the enteral route as the primary nutritional support in this postoperative complication," remark Stanislaw Klek (Jagiellonian University Medical College, Krakow, Poland) and colleagues.
Writing in the journal Gastroenterology, Klek and team report that 78 patients with postoperative pancreatic fistulae were randomly allocated to receive enteral nutrition (EN; n=40) or TPN (n=38) for 30 days.
A significantly higher 30-day fistula closure rate occurred among patients who received EN compared with those in the TPN group, at 60% versus 37%, reflecting a 2.5-fold higher likelihood of fistula closure with EN than TPN (p=0.043).
Furthermore, only patients in the EN group had a median time to closure that fell within the study period, at 27 days.
The median time taken to achieve a 50% reduction in fistula output (an alternative measure of closure rate) was also shorter among the patients who received EN compared with TPN, at 18 versus 21 days.
Further analysis revealed two independent predictors of fistula closure - EN and an initial fistula output of 200 ml/day or less.
"Enteral feeding appears as an effective, safe, and cost-effective therapeutic option in patients with postoperative pancreatic fistula," comment Klek and colleagues.
They conclude: "Further clinical trials should address the benefits of multidisciplinary therapy of pancreatic fistulas with enteral nutrition combined with other interventions." analogues."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Lauretta Ihonor