Percutaneous Gastrostomy in Necrotizing Pancreatitis: Friend or Foe?

Alexandra M. Roch, Rosalie A. Carr, James L. Watkins, Glen Lehman, Michael G. House, Attila Nakeeb, C. Max Schmidt, Eugene P. Ceppa, Nicholas J. Zyromski

Research output: Contribution to journalArticle

Abstract

Background: Enteral nutrition plays a central role in managing necrotizing pancreatitis (NP). Although the nasojejunal (NJ) route is widely used, percutaneous gastrostomy (PEG-J) is an alternative technique that is also applied commonly. We hypothesized that NJ and PEG-J had similar morbidity in the setting of NP. Methods: All patients receiving preoperative enteral nutrition before surgical debridement for NP (2005–2015) were segregated into NJ or PEG-J. Results: A total of 242 patients had complete data for analysis (155 men/87 women; median age 54 years; 47% biliary and 16% alcohol-related pancreatitis). NJ was used exclusively in 187 patients (77%); 25 patients (10%) were fed exclusively by PEG-J; the remaining 30 patients (13%) had NJ first, followed by PEG-J. Equal proportions of NJ and PEG-J patients reached enteral feeding goal (67% vs. 68%, p ≈ 1) and increased serum albumin (39% vs. 36%, p = 0.87). No difference was seen in rate of pancreatic necrosis infection (NJ 53% vs. PEG-J 49%, p = 0.64). NJ patients had significantly more complications compared to PEG-J (51%vs.27%,p = 0.0015). However, NJ patients had more grade I/II complication, compared to PEG-J patients, who had more grade III/IV complication (Grade I/II: NJ 51%vs. PEG-J 16%; Grade III/IV NJ 0%vs. PEG-J 11%, p < 0.0001). Conclusion: In necrotizing pancreatitis, NJ and PEG-J both delivered enteral nutrition effectively. Patients with NJ feeding had significantly more complications than those with PEG-J; however, NJ complications were less severe.

Original languageEnglish (US)
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Gastrostomy
Pancreatitis
Enteral Nutrition
Debridement
Serum Albumin
Necrosis
Alcohols
Morbidity

Keywords

  • Enteral feeding
  • Gastrostomy
  • Nasojejunal feeding
  • Necrotizing pancreatitis
  • PEG

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Percutaneous Gastrostomy in Necrotizing Pancreatitis : Friend or Foe? / Roch, Alexandra M.; Carr, Rosalie A.; Watkins, James L.; Lehman, Glen; House, Michael G.; Nakeeb, Attila; Schmidt, C. Max; Ceppa, Eugene P.; Zyromski, Nicholas J.

In: Journal of Gastrointestinal Surgery, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Percutaneous Gastrostomy in Necrotizing Pancreatitis: Friend or Foe?",
abstract = "Background: Enteral nutrition plays a central role in managing necrotizing pancreatitis (NP). Although the nasojejunal (NJ) route is widely used, percutaneous gastrostomy (PEG-J) is an alternative technique that is also applied commonly. We hypothesized that NJ and PEG-J had similar morbidity in the setting of NP. Methods: All patients receiving preoperative enteral nutrition before surgical debridement for NP (2005–2015) were segregated into NJ or PEG-J. Results: A total of 242 patients had complete data for analysis (155 men/87 women; median age 54 years; 47{\%} biliary and 16{\%} alcohol-related pancreatitis). NJ was used exclusively in 187 patients (77{\%}); 25 patients (10{\%}) were fed exclusively by PEG-J; the remaining 30 patients (13{\%}) had NJ first, followed by PEG-J. Equal proportions of NJ and PEG-J patients reached enteral feeding goal (67{\%} vs. 68{\%}, p ≈ 1) and increased serum albumin (39{\%} vs. 36{\%}, p = 0.87). No difference was seen in rate of pancreatic necrosis infection (NJ 53{\%} vs. PEG-J 49{\%}, p = 0.64). NJ patients had significantly more complications compared to PEG-J (51{\%}vs.27{\%},p = 0.0015). However, NJ patients had more grade I/II complication, compared to PEG-J patients, who had more grade III/IV complication (Grade I/II: NJ 51{\%}vs. PEG-J 16{\%}; Grade III/IV NJ 0{\%}vs. PEG-J 11{\%}, p < 0.0001). Conclusion: In necrotizing pancreatitis, NJ and PEG-J both delivered enteral nutrition effectively. Patients with NJ feeding had significantly more complications than those with PEG-J; however, NJ complications were less severe.",
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AU - Roch, Alexandra M.

AU - Carr, Rosalie A.

AU - Watkins, James L.

AU - Lehman, Glen

AU - House, Michael G.

AU - Nakeeb, Attila

AU - Schmidt, C. Max

AU - Ceppa, Eugene P.

AU - Zyromski, Nicholas J.

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AB - Background: Enteral nutrition plays a central role in managing necrotizing pancreatitis (NP). Although the nasojejunal (NJ) route is widely used, percutaneous gastrostomy (PEG-J) is an alternative technique that is also applied commonly. We hypothesized that NJ and PEG-J had similar morbidity in the setting of NP. Methods: All patients receiving preoperative enteral nutrition before surgical debridement for NP (2005–2015) were segregated into NJ or PEG-J. Results: A total of 242 patients had complete data for analysis (155 men/87 women; median age 54 years; 47% biliary and 16% alcohol-related pancreatitis). NJ was used exclusively in 187 patients (77%); 25 patients (10%) were fed exclusively by PEG-J; the remaining 30 patients (13%) had NJ first, followed by PEG-J. Equal proportions of NJ and PEG-J patients reached enteral feeding goal (67% vs. 68%, p ≈ 1) and increased serum albumin (39% vs. 36%, p = 0.87). No difference was seen in rate of pancreatic necrosis infection (NJ 53% vs. PEG-J 49%, p = 0.64). NJ patients had significantly more complications compared to PEG-J (51%vs.27%,p = 0.0015). However, NJ patients had more grade I/II complication, compared to PEG-J patients, who had more grade III/IV complication (Grade I/II: NJ 51%vs. PEG-J 16%; Grade III/IV NJ 0%vs. PEG-J 11%, p < 0.0001). Conclusion: In necrotizing pancreatitis, NJ and PEG-J both delivered enteral nutrition effectively. Patients with NJ feeding had significantly more complications than those with PEG-J; however, NJ complications were less severe.

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KW - Necrotizing pancreatitis

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