Kể từ đó, có một số nghiên cứu đã tái tạo những kết quả này, mặc dù một lợi ích thuyết phục tỷ lệ tử vong đã không được chứng minh (Imrie et al, 2002). Gần đây nhất đã có báo cáo rằng ăn NG được dung nạp tốt ở những bệnh nhân này. | 782 Advanced Therapy in Gastroenterology and Liver Disease Since then there have been several studies that have reproduced these results although a convincing benefit in mortality has not been demonstrated Imrie et al 2002 . Most recently there have been reports that NG feeding is well tolerated in these patients. Our practice is to begin enteral feeding in patients by an endoscopically or radiologically placed nasojejunal feeding tube after day 2 or 3 in patients with severe pancreatitis. Feeding is started at low rate of 20 cc hr. Although this does not provide complete caloric requirements small amounts of feeding are usually tolerated and may preserve the intestinal barrier. If nausea and vomiting are present a NG tube can be placed and kept to drainage. A small group of patients between 10 to 20 will not tolerate this method of feeding and require TPN. Triglyceride levels should be checked after the onset of feeding especially in patients with known hypertriglyceridemia. Pharmacotherapy with Cytokines Enzyme Inhibitors and Anti-Inflammatory Agents Multiple cytokines and anti-inflammatory mediators have been implicated in the pathogenesis of acute pancreatitis. Thus blockage by a single agent eg interleukin-10 lexipafant has not been effective in the treatment of pancreatitis. Surgical Therapy and Management of Other Complications Surgical therapy is used to treat infected necrosis or complications. The following chapter is on surgical management of pancreatitis. Surgical management includes necrosectomy to remove necrotic tissue with intraoperative and postoperative lavage of debris and pancreatic fluids. Percutaneous catheter-directed debridement of infected necrosis has been described but is best directed to patients who are hemodynamically and clinical stable. Further a number of these patients will subsequently require surgery. It is not our practice to recommend percutaneous drainage except in carefully selected patients with pancreatic abscesses. .
