Total parenteral nutrition in pancreatic disease.

Total parenteral nutrition (TPN) was given to 121 patients admitted with severe pancreatitis (73), chronic pancreatitis (23), or pancreatic malignancy (25) over 104 months. No adverse effects on the pancreas were detected from the TPN, including the provision of intravenous (IV) fat. Nutritional status was maintained or improved in all groups, including patients undergoing surgical procedures and those experiencing marked stress. No significant impact on the clinical course of pancreatitis was observed, although the death rate in acute pancreatitis (15.2%) and complicated pancreatitis (18.5%) compares favorably with other published series where early surgical intervention was undertaken. There was an increased risk of catheter-related sepsis in patients with complicated pancreatitis (14.8%) and with chronic pancreatitis (17.4%). No increase septic risk was seen in patients with acute pancreatitis or pancreatic malignancy. Eighty-two per cent of patients with acute pancreatitis required an average of 87 units of insulin per day while 78% of patients with chronic pancreatitis required an average of 54 units per day. In summary, TPN proved to be safe, effective, and well-tolerated in those patients with disorders of the pancreas.

Duke Scholars

Author John Palmer Grant Surgery, Minimally Invasive Surgery