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Difficult Decisions in Hepatobiliary and Pancreatic Surgery pp 411–420Cite as

Nutritional Support in Acute Necrotizing Pancreatitis

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Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

Abstract

Enteral nutrition (EN) is now considered the standard of care for patients with severe acute pancreatitis and patients with pancreatic necrosis. Several randomized controlled trials and meta-analyses have shown that the administration of EN nutrition reduces complications and mortality of patients with severe pancreatitis including patients with pancreatic necrosis compared to parenteral nutrition (PN). PN had been the standard of care for many decades, based on the concept of “pancreatic rest”. Avoidance of alimentary stimulation of pancreatic exocrine secretion was assumed to limit or prevent ongoing pancreatic inflammation. Current practice guidelines recommend the use of enteral nutrition for feeding patients with acute pancreatitis, including those with pancreatic necrosis. Accumulating evidence suggests that the use of the gut through EN may promote the maintenance of gut barrier and immune functions. Provision of luminal nutrition via the gastric approach appears to be equally tolerated as the enteral route and may be more cost effective. However, larger randomized controlled trials and other studies focused on optimization of nutritional support during the acute and convalescent phases of necrotizing pancreatitis are needed. Pharmaconutriton or the use of defined elemental formulae has not yet been shown to be beneficial. The use of PN should be limited to patients that cannot tolerate EN.

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Authors and Affiliations

  1. Department of Medicine, The University of Chicago Medicine, 5841 S. Maryland Ave. Rm. M408, MC4076, Chicago, IL, 60637, USA

    Andreas Mykoniatis

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  1. Andreas Mykoniatis
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Correspondence to Andreas Mykoniatis .

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Editors and Affiliations

  1. The University of Chicago, CHICAGO, Illinois, USA

    J. Michael Millis

  2. The University of Chicago, CHICAGO, Illinois, USA

    Jeffrey B. Matthews

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Mykoniatis, A. (2016). Nutritional Support in Acute Necrotizing Pancreatitis. In: Millis, J., Matthews, J. (eds) Difficult Decisions in Hepatobiliary and Pancreatic Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-27365-5_37

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  • DOI: https://doi.org/10.1007/978-3-319-27365-5_37

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