Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis

Abstract

Objective: To compare the safety and clinical outcomes of enteral and parenteral nutrition in patients with acute pancreatitis.

Data sources: Medline, Embase, Cochrane controlled trials register, and citation review of relevant primary and review articles.

Study selection: Randomised controlled studies that compared enteral nutrition with parenteral nutrition in patients with acute pancreatitis. From 117 articles screened, six were identified as randomised controlled trials and were included for data extraction.

Data extraction: Six studies with 263 participants were analysed. Descriptive and outcome data were extracted. Main outcome measures were infections, complications other than infections, operative interventions, length of hospital stay, and mortality. The meta-analysis was performed with the random effects model.

Data synthesis: Enteral nutrition was associated with a significantly lower incidence of infections (relative risk 0.45; 95% confidence interval 0.26 to 0.78, P = 0.004), reduced surgical interventions to control pancreatitis (0.48, 0.22 to 1.0, P = 0.05), and a reduced length of hospital stay (mean reduction 2.9 days, 1.6 days to 4.3 days, P < 0.001). There were no significant differences in mortality (relative risk 0.66, 0.32 to 1.37, P = 0.3) or non-infectious complications (0.61, 0.31 to 1.22, P = 0.16) between the two groups of patients.

Conclusions: Enteral nutrition should be the preferred route of nutritional support in patients with acute pancreatitis.

Figures

Fig 1

Process of study selection of randomised controlled trials (TPN=total parenteral nutrition; ENT=enteral nutrition; PN=parenteral nutrition)

Fig 2

Risk of infection, complications other than infection, surgical intervention, and mortality; results from meta-analyses of randomised trials comparing enteral with parenteral nutrition in pancreatitis

Fig 3

Random effects model of relative risk (95% confidence interval) of infections associated with enteral feeding compared with parenteral nutrition