Nasojejunal Feeding in Pancreatitis: A Single Center Experience

Purpose: The traditional standard practice for the management of acute pancreatitis has been bowel rest and pain control. With recent data, though, this paradigm is shifting toward early enteral feeding as way of providing nutrition and possibly decreasing complication and cost of parenteral nutrition. We have retrospectively reviewed 10 patients where a nasojejunal tube was placed for feeding in acute pancreatitis. Methods: Inpatient records reviewed for patients admitted for acute pancreatitis at our institution who underwent endoscopic nasojejunal placement. We examined demographic data, ICU length of stay, hospital length of stay and clinical outcomes. In all cases either a pediatric upper endoscope or the Olympus XP 180N ultraslim gastroscope was inserted into the nares. A guidewire (0.035 mm hydrophilic wire) was placed under direct vision and fluoroscopy (when available). The endoscope was subsequently removed and either a 10fr or 16fr nasojejunal tube was advanced over the wire into the small intestine and confirmed under fluoroscopy or subsequent xray. Results: From February 2010 through October 2010 a total of 17 endoscopies for the purpose of Nasojejunal feeding were performed in 10 patients. The average Ranson score was 4.75 (range1-8). Most patients were managed in the ICU as part of their admission with an average stay of 31 days. Immediate success was achieved in 82.4% (14 of 17 cases). A total of 5 patients needed to undergo repeat procedures (dislodgement: 3; malfunction: 2). The average duration of nasojejunal feeding was 14.3 days for each procedure and 22.9 days for each patient when one includes replacement. Two patients were able to be discharged home with their tubes in place while receiving enteral feeds. The reason for discontinuation varied, but included dislodgement (intentional or unintentional) in four patients, malfunction (either blocked or kinked) in two patients, tolerating diet in two patients, or surgical placement of a jejunal tube in two patients. Conclusion: Nasojejunal feeding is an acceptable alternative to parenteral nutrition in patients with acute pancreatitis. Endoscopic placement is achievable in greater than 80% of cases with 50% of patients needing repeat endoscopic placement. It is also possible to manage some patients on an outpatient basis with nasojejunal feeding.