Parenteral Nutrition in Pancreatitis is Passé: But Are We Ready for Gastric Feeding? A Practical Guide to Jejunal Feeding: Revenge of the Cyst –Part II

Nutrition support is required to prevent or reverse malnutrition in the 15%–20% of patients that develop severe or complicated pancreatitis who are unable to resume oral intake in seven-to-ten days. The best available data supports the use of jejunal feeding over parenteral nutrition in those patients. Jejunal enteral nutrition can be successfully achieved by using nasojejunal access (in those patients requiring <30 days of nutrition support) and either percutaneous endoscopic gastrostomy with jejunal extension or direct percutaneous jejunostomy access in patients requiring longer support. Symptoms such as diarrhea, nausea, vomiting, abdominal pain, and excessive gastric secretion may appear to be obstacles to successful enteral feeding, but our experience demonstrates that patients rarely remain intolerant to enteral feeding and require parenteral nutrition. The transient gastrointestinal symptoms associated with enteral feeding can be managed by the following recommendations outlined in this article. The use of long term enteral nutrition in patients with chronic pain, pseudocysts, malnutrition and other complications is increasing, but the efficacy of this practice still needs to be clearly demonstrated in randomized controlled trials. Joe Krenitsky Diklar Makola Carol Rees Parrish