Successful Long-Term Jejunostomy Feedings in Relapsing Pancreatitis: A Case Report

Abstract

Relapsing pancreatitis is characterized by repeated episodes of acute inflammation of the pancreas, with either a localized or a systemic organic response that may progress to chronic pancreatitis. Enteral jejunal feedings have been shown to be effective in the management of acute pancreatitis, but long-term use of jejunal feedings as treatment of relapsing pancreatitis has not been reported. We describe the case of a young patient treated with long-term jejunal feedings to induce remission and prevent recurrence of acute relapsing pancreatitis. An 18-year-old Hispanic man had well-documented recurrent episodes of acute pancreatitis. Multiple studies were performed as part of the diagnostic workup of the patient's relapsing pancreatitis, including endoscopic ultrasound, endoscopic retrograde cholangiopancreatography with biliary sphincterotomy, and laparoscopic cholecystectomy. Despite medical therapy, endoscopic and surgical procedures, the patient continued having episodes of pancreatitis on a monthly basis, with over 13 distinct documented episodes of pancreatitis during a 15-month period. A jejunostomy tube was inserted surgically, and long-term jejunal feedings were instituted, with excellent control of the patient's symptoms. There was only 1 episode of pancreatitis in the ensuing 24 months associated with the resumption of oral feedings and a weight gain of 20 pounds during this time period. Chronic jejunal feedings seem to be an effective alternative for treatment and prevention of acute relapsing pancreatitis. To our knowledge, this is the first report of long-term enteral feedings in acute relapsing pancreatitis.

We describe the use of long-term jejunal feedings for treatment and prevention of relapsing pancreatitis (RP). After starting jejunal feedings, the patient only had 1 episode of pancreatitis in a 24-month period, which occurred when resuming oral diet. Jejunal feedings appear to be a good alternative treatment for patients with RP when other therapies fail.

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References

Mitchell RM, Byrne MF, Baillie J. Pancreatitis.Lancet. 2003;361:1447– 1455.

Cohn JA, Friedman KJ, Noone PG, Knowles MR, Silverman LM, Jowell PS. Relation between mutations of the cystic fibrosis gene and idiopathic pancreatitis. N Engl J Med. 1998 ;339:653– 658.

Kulczycki LL, Kostuch M, Bellanti JA. A clinical perspective of cystic fibrosis and new genetic findings: relationship of CFTR mutations to genotype-phenotype manifestations. Am J Med Genet A. 2003 ;116:262– 267.

Knowles M, Gatzy J, Boucher R. Relative ion permeability of normal and cystic fibrosis nasal epithelium. J Clin Invest. 1983 ;71:1410– 1417.

Kunzelmann K, Schreiber R, Nitschke R, Mall M. Control of epithelial Na+ conductance by the cystic fibrosis transmembrane conductance regulator. Pflugers Arch. 2000 ;440:193– 201.

Sharer N, Schwarz M, Malone G, et al. Mutations of the cystic fibrosis gene in patients with chronic pancreatitis. N Engl J Med. 1998;339:645– 652.

Lebenthal E, Lerner A, Rolston DDK. The pancreas in cystic fibrosis. In: Go VLW, DiMagno EP, Gardner JD, Lebenthal E, Reber HA, Scheele GA, eds. The Pancreas: Biology, Pathobiology, and Disease. 2nd ed. New York, NY: Raven Press; 1993:1041– 1081.

Shintaku M, Umehara Y, Iwaisako K, Tahara M, Adachi Y. Herpes simplex pancreatitis. Arch Pathol Lab Med. 2003 ;127:231– 234.

Nompleggi DJ. Nutrition in acute pancreatitis. Curr Gastroenterol Rep. 1999;1:319– 323.

10.

Grant JP, James S, Grabowski V, Trexler KM. Total parenteral nutrition in pancreatic disease. Ann Surg. 1984 ;200:627– 631.

11.

Kudsk KA, Campbell SM, O'Brien T, Fuller R. Postoperative jejunal feedings following complicated pancreatitis. Nutr Clin Pract. 1990 ;5:14– 17.

12.

McClave SA, Snider HL, Spain DA. Nutritional management in acute and chronic pancreatitis. Gastroenterol Clin North Am. 1998 ;27:421– 434.

13.

Cerra FB, Benitez MR, Blackburn GL, et al. Applied nutrition in ICU patients: a consensus statement of the American College of Chest Physicians.Chest. 1997;111:769– 778.

14.

Gorman RC, Morris JB. Minimally invasive access to the gastrointestinal tract. In: Rombeau JL, Rolandelli RH, eds. Clinical Nutrition: Enteral and Tube Feeding. 3rd ed. Philadelphia, PA: W.B. Saunders Company; 1997:174– 192.

15.

Stanga Z, Giger U, Marx A, DeLegge MH. Effect of jejunal long-term feeding in chronic pancreatitis. JPEN J Parenter Enteral Nutr. 2005 ;29:12– 20.

16.

Abou-Assi S, O'Keefe SJ. Nutrition support during acute pancreatitis. Nutrition. 2002 ;18:938– 943.

17.

Hamvas J, Schwab R, Pap A. Jejunal feeding in chronic pancreatitis with severe necrosis. JOP. 2001 ;2:112– 116.

18.

Nakad A, Piessevaux H, Marot JC, et al. Is early enteral nutrition in acute pancreatitis dangerous? About 20 patients fed by an endoscopically placed nasogastrojejunal tube. Pancreas. 1998 ;17:187– 193.

19.

Shea JC, Hopper IK, Blanco PG, Freedman SD. Advances in nutritional management of chronic pancreatitis. Curr Gastroenterol Rep. 2000 ;2:323– 326.

20.

Erstad BL. Enteral nutrition support in acute pancreatitis.Ann Pharmacother. 2000;34:514– 521.

21.

Hamvas J, Pap A. The role of jejunal feeding in the treatment of acute necrotizing pancreatitis and in recurrence of chronic pancreatitis with severe necrosis. Orv Hetil. 1998 ;139:945– 949.

22.

Yoder AJ, Parrish CR, Yeaton P. A retrospective review of the course of patients with pancreatitis discharged on jejunal feedings.Nutr Clin Pract. 2002;17:314– 320.