Study of Nutrition in Acute Pancreatitis (SNAP)

University of Pittsburgh

Status

Terminated

Conditions

Pancreatitis

Treatments

Procedure: Naso jejunal feeding tube insertion

Procedure: NG feeding tube insertion

Study type

Interventional

Funder types

Other

NIH

Identifiers

NCT00580749

1 R01 DK 075803-01A1 NIH#

PRO 07080011, PRO 07080044

Details and patient eligibility

About

We will compare the two types of enteral (intestinal) nutrition in regard to patients with severe acute pancreatitis in our institution and also in 8 others in the United States.

Enrollment

23 patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Patients over the age of 18yr
The typical history of abdominal pain for over 24h with raised (>3-fold) serum pancreatic enzymes on admission
Severe pancreatitis, as defined by: the Atlanta classification of severe disease (60), but with important modifications to sharpen the definition of severity, to include one or more of the following:
1. The presence of organ failure (MOF) resistant to early aggressive IV fluid resuscitation as defined by a Marshall score of ≥2 in any one organ (for calculation, see Appendix (61)), excluding the liver component as the abnormality may be due to gall stones rather than the systemic inflammatory response (17)
2. Pancreatic necrosis >30% on CT scan or a modified CT severity index (CTSI: see Appendix (62)) of ≥8
3. APACHE score ≥ 8 (for calculation, see Appendix (63))
4. Ranson's criteria ≥3 (for calculation, see Appendix (64))

Exclusion criteria

Inability to absorb enteral nutrients resulting in chronic intestinal failure and need for IV feeding, such as short bowel, malabsorption disorders such as celiac or intestinal proliferative disorders, chronic obstruction and pseudo-obstruction.
Time elapse since commencement of acute pancreatitis symptoms >10 days. In order to take advantage of the 'window of opportunity' to prevent the progression of 'transient' MOF to 'permanent' MOF, patients should be started on enteral feeding as soon as possible. However, in practice many patients present initially with mild disease which progresses to severe necrosis at the end of the first week, and these patients need nutritional support for long periods of time. Consequently, this is an important group to include in this investigation. Post hoc analysis will be performed to see whether they behave differently to patients fed earlier in their disease
Any form of artificial feeding since commencement of acute pancreatitis symptoms
Patients with chronic pancreatitis and pancreatic insufficiency requiring pancreatic enzyme supplements, based on clinical history and specific investigations such as by ERCP, MRP, or CT scanning.
Pre-existing chronic renal insufficiency requiring hemodialysis or peritoneal dialysis, as this will make assessment of severity difficult
Pre-existing end-stage liver disease with ascites, coagulopathy and encephalopathy, supported by biopsy, and/or radiological imaging and endoscopy (portal hypertension, varices and gastropathy), as this will make assessment of severity difficult
Chronic immunodeficiency states such as AIDS defined by CD-4 count < 50, and immunoglobulin deficiencies as it may independently affect feeding tolerance and infection risk
Pancreatic cancer proven by biopsy, and any other form of cancer with life-expectancy <6 months.
Current somatostatin or corticosteroid therapy as these drugs will impair intestinal, metabolic, and immune function, and therefore affect absorption and infection risk.
Contraindication to using the nose for enteral tube insertion
Severe traumatic brain injury with ICP>20mmHg despite treatment
Previous completion or withdrawal from this study