Prognostic Tests of Intolerance to Postpyloric Feeding in Early Acute Pancreatitis
Aim. To evaluate the eﬀectiveness of postpyloric feeding in early predicted severe acute pancreatitis using acetaminophen absorption test and gastric emptying rate.Material and methods. An open observational prospective cohort study in the intensive care unit of OAO «Neftyanik» hospital in the city of Tyumen, Russia, from November 2012 to October 2018 was performed. All included patients were diagnosed with predicted severe acute pancreatitis (inclusion criterion). The rate of gastric emptying was assessed using an original ultrasound technique which involved measuring the ﬂuid volume 30 min and 60 min after administering of 200 mL aliquote of water into the stomach. Acetaminophen absorption test was performed according to the following procedure: 0.5 g of acetaminophen was administered through the nasojunal tube placed 30-40 cm distal to the Treitz ligament using endoscope, the blood level of the drug was measured 5-20 min later.Results. Gastric ﬂuid volume at 60 min (OR=1.049, 95% CI: 1.028-1.07, P<0.001 with AUC=0.921, 95% CI: 0.808-0.944 and cutoﬀ value of 73.5) was a signiﬁcant predictor of residual gastric volume ≥ 500 mL/d and intolerance to enteral feeding through the nasojejunal tube (OR=1.023, 95% CI: 1.009-1.036, P=0.001 with AUC 0.752, 95% CI: 0.629-0.875, with cutoﬀ value of 79.5). The acetaminophen small intestine absorption test was reliable in predicting the residual gastric volume ≥ 500 mL/d for the early period of disease. The acetaminophen absorption test was a signiﬁcant predictor of intolerance to enteral feeding through the nasojejunal tube only in patients with severe acute pancreatitis (OR=0.834, 95% CI: 0.733-0.949, P<0.001 with AUC=0.894, 95% CI: 0.770-0.1 with cutoﬀ value of 14.6).Conclusion. Throughout the early period of acute pancreatitis, gastric ﬂuid volume measured 60 min after the administration of 200 mL of water, accurately predicts the residual gastric volume I 500 mL/day. Acetaminophen absorption test in the small intestine can reliably predict intolerance to postpyloric feeding only for patients with severe acute pancreatitis.