Document Detail

Enteral and Parenteral Nutrition in the Conservative Treatment of Pancreatic Fistula - a Randomized Clinical Trial.
MedLine Citation:
PMID:  21439962     Owner:  NLM     Status:  Publisher    
BACKGROUND & AIMS: Postoperative pancreatic fistula is the most common and potentially life-threatening complication after pancreatic surgery. Although nutritional support is a key component of conservative therapy in such cases, there have been no well-designed clinical trials substantiating the superiority of either total parenteral nutrition (TPN) or enteral nutrition (EN). This study was conducted to compare the efficacy and safety of both routes of nutritional intervention. METHODS: A randomized clinical trial was conducted in a tertiary surgical center of pancreatic and gastrointestinal surgery. Seventy-eight patients with postoperative pancreatic fistula were treated conservatively and randomly assigned to groups receiving for 30 days either enteral nutrition or total parenteral nutrition. The primary endpoint was the 30-day fistula closure rate. RESULTS: After 30 days, closure rates in patients receiving enteral and parenteral nutrition were 60% (24 of 40) and 37% (14 of 38), respectively (P=0.043). The odds ratio for the probability that fistula closes on EN compared to TPN was 2.571 (95%CI 1.031 to 6.411). Median time to closure was 27 days (95%CI 21 to 33) for enteral nutrition and no median time was reached in TPN (P=0.047). A logistic regression analysis identified only two factors significantly associated with fistula closure, i.e. enteral nutrition (odds ratio 6.136, 95%CI 1.204 to 41.623, P=0.043) and initial fistula output of 200 ml/d or less (odds ratio 12.701, 95%CI 9.102 to 47.241, P<0.001). CONCLUSIONS: Enteral nutrition is associated with significantly higher closure rates and shorter time to closure of postoperative pancreatic fistula.
Stanislaw Klek; Marek Sierzega; Lukasz Turczynowski; Piotr Szybinski; Kinga Szczepanek; Jan Kulig
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-23
Journal Detail:
Title:  Gastroenterology     Volume:  -     ISSN:  1528-0012     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-3-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.
1(st) Department of Surgery, Jagiellonian University Medical College, Krakow, Poland.
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