1. Nutrition (ESPEN Guidelines 2020)3
Early v Late
- Early feeding (<48 hours) has shown a reduction in infected necrosis, organ failure and need for invasive intervention
- Those with mild pancreatitis can eat and drink as soon as able. The majority can tolerate diet and do not require gut rest
- Enteral Support should be considered within 24-72 hours if oral diet is not possible
Route of Delivery
- Parenteral Nutrition was once thought to be beneficial as it could potentially limit activation of the pancreatic exocrine system, but parenteral nutrition is not without its own risks and complications
- Enteral feeding has beneficial effects on maintenance of both function and structure of the gut mucosa, particularly with respect to prevention of bacterial translocation
- There is consistent evidence that enteral feeding reduces mortality and infective complications.
- When enteral feeding is indicated NG feed should be the first line. NJ feeding is reserved for those who fail to establish feed via the NG route.
Formulation
- Elemental feeds have been suggested as a way of reducing pancreatic stimulation. There is inadequate evidence to support the use of these at present. This also applies to probiotics and immune-nutrition
2. Gallstones
- Mild Pancreatitis – Consider cholecystectomy before discharge
3. Antibiotics
- The role of prophylactic antibiotics to prevent infection in pancreatitis has been long debated
- The most recent literature appears to suggest no benefit in mortality or morbidity with prophylactic antibiotic therapy
- Antibiotics should be used where evidence of infected pancreatic necrosis exists (or signs of extra-pancreatic infection)4
- Detecting evidence of infected necrosis can often be clinically challenging
- Procalcitonin (PCT) may be a useful tool when suspecting infected necrosis
4.Involvement of Local HPB Team
- The following patients should be referred:
- Severe acute pancreatitis or inpatient for >2 Weeks 5
- Presence of any local complication
