Percutaneous Gastrostomy in Necrotizing Pancreatitis: Friend or Foe?

  • Alexandra M. Roch
  • Rosalie A. Carr
  • James L. Watkins
  • Glen Lehman
  • Michael G. House
  • Attila Nakeeb
  • C. Max Schmidt
  • Eugene P. Ceppa
  • Nicholas J. ZyromskiEmail author
Original Article



Enteral nutrition plays a central role in managing necrotizing pancreatitis (NP). Although the nasojejunal (NJ) route is widely used, percutaneous gastrostomy (PEG-J) is an alternative technique that is also applied commonly. We hypothesized that NJ and PEG-J had similar morbidity in the setting of NP.


All patients receiving preoperative enteral nutrition before surgical debridement for NP (2005–2015) were segregated into NJ or PEG-J.


A total of 242 patients had complete data for analysis (155 men/87 women; median age 54 years; 47% biliary and 16% alcohol-related pancreatitis). NJ was used exclusively in 187 patients (77%); 25 patients (10%) were fed exclusively by PEG-J; the remaining 30 patients (13%) had NJ first, followed by PEG-J. Equal proportions of NJ and PEG-J patients reached enteral feeding goal (67% vs. 68%, p ≈ 1) and increased serum albumin (39% vs. 36%, p = 0.87). No difference was seen in rate of pancreatic necrosis infection (NJ 53% vs. PEG-J 49%, p = 0.64). NJ patients had significantly more complications compared to PEG-J (51%vs.27%,p = 0.0015). However, NJ patients had more grade I/II complication, compared to PEG-J patients, who had more grade III/IV complication (Grade I/II: NJ 51%vs. PEG-J 16%; Grade III/IV NJ 0%vs. PEG-J 11%, p < 0.0001).


In necrotizing pancreatitis, NJ and PEG-J both delivered enteral nutrition effectively. Patients with NJ feeding had significantly more complications than those with PEG-J; however, NJ complications were less severe.


Gastrostomy Necrotizing pancreatitis PEG Nasojejunal feeding Enteral feeding 


Author Contributions

Conception or design of the work: Zyromski, Roch

Acquisition of data: Roch, Carr

Analysis of data: Roch, Carr, Zyromski

Interpretation of data: Roch, Carr, Watkins, Lehman, House, Nakeeb, Schmidt, Ceppa, Zyromski

Drafting or revising of the work for important intellectual content: Roch, Carr, Watkins, Lehman, House, Nakeeb, Schmidt, Ceppa, Zyromski

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Alexandra M. Roch
    • 1
  • Rosalie A. Carr
    • 1
  • James L. Watkins
    • 2
  • Glen Lehman
    • 2
  • Michael G. House
    • 1
  • Attila Nakeeb
    • 1
  • C. Max Schmidt
    • 1
  • Eugene P. Ceppa
    • 1
  • Nicholas J. Zyromski
    • 1
    Email author
  1. 1.Department of SurgeryIndiana University School of MedicineIndianapolisUSA
  2. 2.Department of Medicine, Division of Gastroenterology and HepatologyIndiana University School of MedicineIndianapolisUSA

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