AIM: To assess the rate of spontaneous tube migration and to compare the effects of naso-gastric and naso-intestinal (NI) (beyond the ligament of Treitz) feeding in severe acute pancreatitis (SAP).METHODS: After bedside intragastric insertion, tube position was assessed, and enteral nutrition (EN) started at day 4, irrespective of tube localization. Patients were monitored daily and clinical and laboratory parameters evaluated to compare the outcome of patients with nasogastric (NG) or NI tube.RESULTS: Spontaneous tube migration to a NI site occurred in 10/25 (40%) prospectively enrolled SAP patients, while in 15 (60%) nutrition was started with a NG tube. Groups were similar for demographics and pancreatitis aetiology but computed tomography (CT) severity index was higher in NG tube patients than in NI (mean 6.2 vs 4.7, P = 0.04). The CT index seemed a risk factor for failed obtainment of spontaneous distal migration. EN trough NG or NI tube were similar in terms of tolerability, safety, clinical goals, complications and hospital stay.CONCLUSION: Spontaneous distal tube migration is successful in 40% of SAP patients, with higher CT severity index predicting intragastric retention; in such cases EN by NG tubes seems to provide a pragmatic alternative opportunity with similar outcomes.
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机译:目的:评估严重急性胰腺炎(SAP)喂养时自发性输卵管迁移率并比较鼻胃和鼻肠(NI)(特雷兹韧带以外)的喂养方法:在床旁胃内插入胃后,输卵管评估位置,并在第4天开始进行肠内营养(EN),而不管管的位置如何。每天监测患者并评估临床和实验室参数,以比较鼻胃(NG)或NI管患者的结局。结果:10/25(40%)的前瞻性入组SAP患者发生自发性移行至NI部位。用NG管开始进行15种(60%)营养。人口统计学和胰腺炎病因学的分组相似,但NG管患者的计算机断层扫描(CT)严重性指数高于NI(平均6.2 vs 4.7,P = 0.04)。 CT指数似乎是自发性远端迁移失败的危险因素。结论:在40%的SAP患者中,成功的自发性远端管迁移成功,且CT严重度指数越高,预示胃内retention留率越高;在低耐受性,安全性,临床目标,并发症和住院方面,EN NG或NI管均相似。在这种情况下,EN by NG管似乎提供了具有类似结果的务实替代机会。
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