Ugh the ever-changing world of medicine – you know what I am talking about. Evidence-based medicine (EMB) comes with its pitfalls of changing results & recommendations if a better designed study shows a different result. EBM is still important though, since what makes logical sense often does not play out in real world clinical evidence.
We were used to using Nasojejunal (NJ) tubes instead of Nasogastric (NG) tubes for feeding patients of severe acute pancreatitis to “bypass the pancreas”, which made perfect logical sense. But multiple randomized controlled trials in the past few years comparing NG feeding to NJ feeding show no clinical advantage of using an NJ over NG . Makes one wonder if going through the extra hassle & cost of using radiology assistance in placing an NJ tube is really worth it. Also in some patients, the additional cost of replacing an NJ if they are accidentally pulled out, and being longer, blockages are more common. A NG on the other hand can be easily placed or re-placed at the bedside.
A 2006 Randomized Controlled Trial (RCT) of 31 patients with acute pancreatitis showed good tolerance in either NG or NJ slow tube-feeding without worsening or recurrence of pancreatitis . The same was shown in a 2012 RCT study of 78 patients, a 2005 RCT study of 50 patients and more recently in a 2021 RCT study in 50 kids as well .
Granted these are small studies, but they all have consistenly shown the same result, so why not try slow NG feeding first in severe pancreatitis and see how the patient does !
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