Nasogastric tube feeding in predicted severe acute pancreatitis. A systematic review of the literature to determine safety and tolerance.

CONTEXT Nasogastric tube feeding is safe and well tolerated in most critically ill patients. However, its safety and tolerance in the setting of severe acute pancreatitis is debatable. OBJECTIVE We aimed to review all available studies on nasogastric feeding in patients with severe acute pancreatitis to determine the safety and tolerance of this approach. A further aim was to perform a meta-analysis of the available randomized controlled trials regarding nasogastric versus nasojejunal feeding. METHODS Three electronic databases (Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE) and the abstracts of major gastroenterological meetings were reviewed. Meta-analysis was performed using the random effects model. MAIN OUTCOME MEASURES The summary estimates were reported as risk ratio (RR) with 95% confidence interval (95% CI). RESULTS A total of four studies on nasogastric tube feeding in 92 patients with predicted severe acute pancreatitis were identified. Documented infected pancreatic necrosis developed in 11 patients (16.9%) and multiple organ failure in 10 (15.4%) out of 65 patients with available data. Overall, there were 15 deaths (16.3%). An exacerbation of pain after initiation of feeding occurred in 3 (4.3%) out of 69 patients with available data. Full tolerance was achieved in 73 (79.3%) patients who did not require temporary reduction, stoppage or withdrawal of nasogastric feeding. The results of nasogastric feeding as compared to nasojejunal feeding, were no worse in terms of mortality (RR=0.77; 95% CI: 0.37 to 1.62; P=0.50) or intolerance of feeding (RR=1.09; 95% CI: 0.46 to 2.59; P=0.84). CONCLUSION Nasogastric feeding appears safe and well tolerated in patients with predicted severe acute pancreatitis. An adequately powered randomized trial on nasogastric versus nasojejunal feeding is required to support this approach as routine clinical management.