Original ResearchClinical—PancreasEnteral and Parenteral Nutrition in the Conservative Treatment of Pancreatic Fistula: A Randomized Clinical Trial
Section snippets
Trial Design and Participants
This parallel randomized clinical trial was carried out at a university-based surgical department specializing in gastrointestinal surgery to evaluate the effects of 2 regimens of nutritional support on the closure rate of POPF (ClinicalTrials.gov number NCT01025414). The study was carried out after the international ethical recommendations stated in the Declaration of Helsinki. The Bioethics Committee of Jagiellonian University approved the protocol of this trial and all the patients gave
Patient Population
Between September 2006 and October 2009, a group of 91 patients was initially screened to participate in the study. Thirteen patients were subsequently excluded and the remaining 78 subjects were allocated into study groups receiving enteral nutrition (n = 40) and parenteral nutrition (n = 38). Reasons for exclusion were abdominal abscess requiring interventional treatment (n = 6), severe malnutrition requiring combined nutritional treatment (n = 3), declining to participate (n = 3), and other
Discussion
The evidence-based approach to postoperative pancreatic fistulas is limited due to the paucity of randomized-clinical trials recruiting adequate numbers of patients. Nevertheless, fasting with nutritional support, adequate drainage, and skin protection are currently the basic aspects of treatment.3, 4, 15 Conservative therapy is preferred for low-output, uncomplicated fistulas, while those persisting for 6–8 weeks and associated with septic complications usually require a more aggressive
References (35)
- et al.
Management of internal and external pancreatic fistulas
Surg Clin North Am
(2007) - et al.
Nutritional management of patients with gastrointestinal fistulas
Surg Clin North Am
(1996) Defining, controlling, and treating a pancreatic fistula
J Gastrointest Surg
(2009)- et al.
Post-operative external fistulas of the digestive tractParenteral or enteral nutrition?
Nutr Clin Metabol
(1994) - et al.
Nutrition support during acute pancreatitis
Nutrition
(2002) - et al.
Postoperative pancreatic fistula: an international study group (ISGPF) definition
Surgery
(2005) - et al.
Pancreatic anastomotic leak after pancreaticoduodenectomy: incidence, significance, and management
Am J Surg
(1994) - et al.
Ileal brake: a sensible food target for appetite controlA review
Physiol Behav
(2008) - et al.
Effect of different caloric loads in human jejunum on meal-stimulated and nonstimulated biliopancreatic secretion
Am J Clin Nutr
(1988) - et al.
Effect of jejunal amino acid perfusion and exogenous cholecystokinin on the exocrine pancreatic and biliary secretions in man
Gastroenterology
(1971)
Surgical treatment of pancreatic fistula
Dig Surg
Pancreatic fistula rate after pancreatic resectionThe importance of definitions
Dig Surg
Optimising the treatment of upper gastrointestinal fistulae
Gut
Contemporary treatment strategies for external pancreatic fistulas
Surgery
Role of octreotide and somatostatin in the treatment of intestinal fistulae
Digestion
Physiological effects of enteral and parenteral feeding on pancreaticobiliary secretion in humans
Am J Physiol Gastrointest Liver Physiol
Effects of parenteral nutrition on the exocrine pancreas in response to cholecystokinin
JPEN J Parenter Enteral Nutr
Cited by (70)
Management of postoperative pancreatic fistula after pancreaticoduodenectomy
2023, Journal of Visceral SurgeryDisconnected pancreatic duct syndrome: Updated review on clinical implications and management
2020, PancreatologyCitation Excerpt :There is no proven role of somatostatin or its analogues in managing patients with DPDS and EPF [28]. Although enteral nutrition has been associated with superior closure rates and earlier closure of post-operative pancreatic fistula as compared to parenteral nutrition, data is lacking in setting of DPDS [29]. Percutaneous drainage is a commonly utilized minimally-invasive intervention in the management of symptomatic PFC associated with acute pancreatitis as a part of step-up approach.
Management of morbidity associated with pancreatic resection during cytoreductive surgery for epithelial ovarian cancer: A systematic review
2020, European Journal of Surgical OncologyCitation Excerpt :A recent RCT comparing enteral feeding with TPN demonstrated that enteral nutrition was effective for the treatment of postoperative pancreatic fistula type B showing two-fold increase in the probability of fistula closure, and shortened time to closure. It was also associated with lower costs when compared to parenteral nutrition [44]. Gerritsen et al., in 2012 conducted a systematic review with the aim to determine which is the optimal feeding route after pancreatectomy.
The fragility of statistically significant results from clinical nutrition randomized controlled trials
2020, Clinical NutritionCitation Excerpt :Title and abstract screening yielded 469 full-text articles for the assessment. Finally, 37 articles were included in qualitative synthesis (Supplement 1) [13–49]. Details of the systematic review and data extraction are provided in the PRISMA Flowchart (Fig. 1).
Pancreatic and duodenal injuries
2023, Acute Care Surgery and Trauma: Evidence-Based Practice: Third Edition
This article has an accompanying continuing education activity on page e19. Learning Objective: Upon completion of this CME exercise, successful learners will be able to recommend treatment method in case of postoperative pancreatic fistula.
Conflicts of interest The authors disclose the following: Dr Klek received educational and research grants from Nutricia Ltd, Fresenius Kabi Ltd, and BBraun Company. The remaining authors disclose no conflicts.
Funding Supported by a research grant from Nutricia Ltd (2006–2009). The funding source did not participate in study design, collection, analysis, or interpretation of the data, or writing of the report. The corresponding author had full access to all of the data and takes full responsibility for the veracity of the data and analysis.