Effects of Early Enteral Nutrition and Its Different Modes of Administration on the Severity of SAP.

Objectives: To observe the effects of enteral nutrition and its different modes of administration on the severity of severe acute pancreatitis (SAP). Methods: SAP was induced in 36 Wistar rats by retrograde injection under pressure of 3.5% sodium taurocholate into the biliopancreatic duct; and in 24 rats, the perfusate was NS instead; and the catheter was introduced into the jejunum via a gastrostomy in all rats.The SAP rats were randomly divided into 3 groups with continuous enteral nutrition(EN), intermittent EN and without EN(n=12 each). Rats with sham EN were also grouped into three sub-groups ( n=8 each). EN was initiated 48 hours later and the rats were sacrificed in 72 hours, tissue and blood samples were collected for further study. Criteria indicating the outcome were: intestinal transmit index, bacterial translocation rate (culture of mesenteric lymph node, liver and splenic tissues), serum amylase, serum cytokine TNF-α, histological score of the pancreas, and the plasma level of D-lactate. Results: ①There was no difference in serum amylase and histological scores between the subgroups with EN and the subgroup without EN 48 hours after the induction of SAP (P0.05). However, early EN may enhance intestinal motility and reduce the bacterial translocation rate (significant difference in intestinal transmit index, organ bacterial translocation rate, and serum TNF-a level ,P0.05). ②There was no difference between the 2 modes of EN according to the criteria used. Conclusions: Jejunal administration of EN via the jejunum is well tolerated in early SAP,it helps to maintain gut physiology and to reduce bacterial translocation, but does not improve the overall outcome. Continuous or intermittent EN are associated with similar outcome in SAP.