~ 33 ~ International Journal of Surgery Science 2020; 4(1): 33-36 E-ISSN: 2616-3470 P-ISSN: 2616-3462 © Surgery Science www.surgeryscience.com 2020; 4(1): 33-36 Received: 19-11-2019 Accepted: 23-12-2019 Dr. Anil Kumar MS Professor, Department of General Surgery, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India Dr. Surendra Mannan K MBBS, Junior Resident, Department of General Surgery, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India Corresponding Author: Dr. Surendra Mannan K MBBS, Junior Resident, Department of General Surgery, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India Comparative study of early enteral feeding versus parenteral feeding in acute severe pancreatitis in JSS hospital Dr. Anil Kumar MS and Dr. Surendra Mannan K DOI: https://doi.org/10.33545/surgery.2020.v4.i1a.307 Abstract Background: Acute Severe acute pancreatitis is found in 20-30% of patients with pancreatitis and is associated with marked increased risk of complications, such as necrosis, abscess, formation of pancreatic pseudocyst and multiorgan failure, and also the disease manifests with a “systemic inflammatory response syndrome (SIRS) that culminates with hyper metabolism and high rate of protein catabolism; consequently, nutritional reserves are rapidly consumed and malnutrition may ensue unless a higher nutritional intake is provided, thus, early nutritional support plays a central role in the management of these patients. Parenteral nutritional support has long been the standard source of exogenous nutrients for these patients; however this is associated with many disadvantages, including dysfunction of the intestinal mucosal barrier, which, in turn, promotes sepsis of intestinal origin. Enteral nutrition, on the other hand, can maintain the integrity and function of the intestinal mucosal barrier, and thus the study intends to compare the efficacy of enteral versus parenteral feeding in influencing the outcomes in acute pancreatitis cases measured in terms of acute phase proteins, duration of ICU care, length of hospital stay. Aim: To compare the efficacy of enteral feeds versus parenteral feeding in terms of, outcomes of acute pancreatitis patients, to assess acute phase response in both types of feeding and measuring the length of hospital stay including length of ICU stay. Methods: Patients admitted with diagnosis of acute pancreatitis will be randomly grouped into group A and B by odd and even number hospital admission, Sample Size is considered as 100 with 50 in group A receiving enteral feeding and 50 in group B receiving parenteral feeding, considering the mean difference in hospital stay of 6 days and SD in each group as 12 days. Results: It was seen that patients who received early enteral nutrition had better outcomes in terms of acute phase proteins, shorter length of hospital stay (p-value:0.038, t-test:7.868) and shorter length of ICU care (p-value: 0.044, t-test:1.094) that compared with total parenteral nutrition group. Conclusion: It can be concluded that in our study, early enteral nutrition can be started safely and efficient when started “within 48 hours of admission” which had better outcomes in terms of acute phase proteins, shorter duration of ICU care and length of hospital stay and also cost effective that compared to those patients who received total parenteral nutrition where lesser patients showed better outcomes, had increased hospital stay and was costlier. Keywords: Systemic inflammatory response syndrome (SIRS), Total parenteral nutrition, enteral nutrition Introduction The definition of acute pancreatitis is an acute condition presenting with abdominal pain and is associated with the raised pancreatic enzyme (3 fold) levels in the blood or urine as a result of pancreatic inflammation. It is associated with marked increased risk of complications, such as necrosis, abscess, formation of pancreatic pseudocyst and multiorgan failure”. And also the disease manifests with a “systemic inflammatory response syndrome (SIRS) that culminates with hyper metabolism and high rate of protein catabolism; consequently, nutritional reserves are rapidly consumed and malnutrition may ensue unless a higher nutritional intake is provided, thus, early nutritional support plays a central role in the management of these patients. Pancreatic rest by keeping the patient nil by mouth and nutritional support by parenteral feeding has long been the standard source of exogenous nutrients for these patients; however this is associated with many disadvantages, including dysfunction or atrophy of the intestinal mucosal gut barrier, which, in turn, promotes sepsis of intestinal origin [2] . Also, bypassing intestine as the prime route of nutrient administration contributes to the loss of “mucosal barrier’s integrity,