[Resumption of enteral nutrition using enteral formula containing sodium alginate following hemorrhaging after endoscopic sphincterotomy: a case report].

[Resumption of enteral nutrition using enteral formula containing sodium alginate following hemorrhaging after endoscopic sphincterotomy: a case report].

Nihon Ronen Igakkai Zasshi. 2017;54(4):573-580

Authors: Akashi T, Matsumoto K, Hashimoto R, Koikawa N, Yamada M, Shimizu J, Kakegawa C, Nakamura M, Kumamoto C

Abstract
Enteral nutrition is often performed in elderly patients with dysphagia. Choledocholithiasis is a disease that is common in elderly patients. Gastrointestinal hemorrhaging can occur in association with endoscopic sphincterotomy, and subsequent enteral nutrition must be carefully resumed. We herein report our experience using Mermed Plus containing sodium alginate after endoscopic hemostasis. The patient was an 88-year-old woman with an onset of gallstone cholangitis during rehabilitation after cerebral infarction. On day 2, endoscopic sphincterotomy and biliary drainage were performed, and the cholangitis was ameliorated. The degree of arousal and swallowing function were unstable, and a liquid diet via the nasogastric tube was initiated from day 6. Anemia progressed on day 7, and melena was observed; as a result, the intravenous administration of a proton pump inhibitor was initiated. On day 8, endoscopic hemostasis of the ulcer proximal to the papilla was performed. From day 10, we focused on the mucosal protective effects of sodium alginate, and Mermed Plus was initiated. No recurrence of hemorrhaging was observed. On day 13, the endoscopic findings revealed that the vicinity of the papilla was covered with solidified liquid diet, and the ulcer had healed. The postoperative course was uneventful, and swallowing training and rehabilitation were performed. On day 26, oral ingestion became possible. Many patients seem to be at risk of developing a gastrointestinal mucosal disorder when receiving enteral nutrition. In such cases, a liquid diet containing sodium alginate as dietary fiber is easy to use and may be useful for resuming enteral nutrition without delay.

PMID: 29213001 [PubMed - in process]

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