A Pilot Study to Assess Tolerability of Early Enteral Nutrition via Esophagostomy Tube Feeding in Dogs with Severe Acute Pancreatitis

Abstract

Background: The putative role of the gut in amplification of systemic inflammation in acute pancreatitis is gaining credence, and intraluminal nutrition has been shown to decrease inflammation in experimental models of pancreatitis. Prepyloric feeding often is used in people with acute pancreatitis, but has not been evaluated in dogs.Hypothesis: Early intervention with enteral nutrition (EN) delivered proximal to the pylorus will be well tolerated in dogs with acute pancreatitis and provide justification for further larger trials.Animals: Ten dogs with severe acute pancreatitis in an open-label, prospective pilot study. Methods: Dogs were treated with plasma transfusion and standard care, and then consecutively assigned to receive either EN via esophagostomy tube feeding or parenteral nutrition (PN). Outcome was used to determine optimal study size for future studies, and complications were compared between the 2 groups.Results: A significantly greater number of vomiting or regurgitating episodes occurred in dogs receiving PN. The dogs receiving EN did not demonstrate any noticeable postprandial pain. There were more catheter-related complications in the PN group. There was no difference in outcome between the 2 treatments, and 43 dogs for each treatment would be required in future studies to determine a difference in outcome.Conclusions and Clinical Relevance: Early EN delivered proximal to the pylorus is well tolerated in dogs with severe pancreatitis and resulted in fewer complications than PN. Prospective trials in a larger cohort are justified to fully establish the potential benefit of early EN, preferably compared with minimal enteral nutrition.

Retrospective evaluation of ProcalAmine administration in a population of hospitalized ICU dogs: 36 cases (2010–2013)

“…The urban location of this hospital may, in part, account for this difference in patient cohorts. Additionally, the preferential use of EN over PN in most pancreatitic patients in recent years may help explain the change in patients selected for PN administration . Polytrauma can result in a marked stress response and significant protein catabolism.…”

Retrospective evaluation of the impact of early enteral nutrition on clinical outcomes in dogs with pancreatitis: 34 cases (2010–2013)

“…The ideal duration of fasting has not been identified in human or veterinary literature, and may likely be patient‐severity dependent if required at all. In fact, further imposed anorexia may be counterproductive to overall gastrointestinal health as avoidance of EN has been correlated to increased gut permeability, bacterial or endotoxin translocation, and immunosuppression . Additionally, the gut itself may either start or contribute to the systemic inflammatory response in AP …”

“…Although studies prospectively evaluating tolerance of enteral feeding in veterinary patients with AP are limited, there is growing evidence supporting the benefits of early EN in this population. A recent small pilot study of dogs with AP demonstrated no exacerbation in signs of pain or vomiting in the enterally fed group when compared to the parenterally fed group . However, there are no trials in veterinary medicine comparing early EN to the traditional therapy of nothing per os (NPO) in AP .…”

Nutrición clínica de perros hospitalizados: Revisión

“…Mansfield et al (2011) verificaram que a NE por meio de esofagostomia, em cães portadores de pancreatite grave e que não estavam aptos a ingerir voluntariamente os nutrientes, resultou em menos complicações do que o uso da NP. Em humanos, o suporte nutricional enteral por meio de tubo de alimentação tem sido eficiente para pacientes disfágicos vítimas de acidente vascular cerebral (Kang et al, 2010).…”

“…Aos poucos o desenvolvimento de técnicas adequadas e os estudos metabólicos e nutricionais permitiram que esse meio de fornecimento de nutrientes, considerado tão utópico, se tornasse realidade PUBVET v.11, n.9, p.901-912, Set., 2017 (Dudrick, 2009). A NP é mais cara do que a NE e tem seu uso restrito ao ambiente hospitalar devido à necessidade da implantação de cateter colocado em condições assépticas (Chan, 2009 , Chan, 2009, Queau et al, 2011, Mansfield et al, 2011.…”