A meta-analysis of enteral nutrition and total parenteral nutrition in patients with acute pancreatitis.

Heming Quan,Chuanyong Guo,Xingpeng Wang

doi:10.1155/2011/698248

Abstract

Objective. To analyze the effect of total parenteral nutrition (TPN) and enteral nutrition (EN) in patients with acute pancreatitis. Methods. Randomized controlled trials of TPN and EN in patients with acute pancreatitis were searched in NCBI and CBM databases and The Cochrane Controlled Trials Register. Six studies were enrolled into the analysis, and the details about the trial designs, characters of the subjects, results of the studies were reviewed by two independent authors and analyzed by STATA 11.0 software. Results. Compared with TPN, EN was associated with a significantly lower incidence of pancreatic infection complications (RR = 0.556, 95% CI 0.436∼0.709, P = .000), MOF (RR = 0.395, 95% CI 0.272∼0.573, P = .003), surgical interventions (RR = 0.556, 95% CI 0.436∼0.709, P = .000), and mortality (RR = 0.426, 95% CI 0.238∼0.764, P = .167). There was no statistic significance in non-pancreatitis-related complications (RR = 0.853, 95% CI 0.490∼1.483, P = .017). However, EN had a significantly higher incidence of non-infection-related complications (RR = 2.697, 95% CI 1.947∼3.735, P = .994). Conclusion. EN could be the preferred nutrition feeding method in patients with acute pancreatitis.

Highlights

Acute pancreatitis is an inflammatory process that presents different severity degrees, ranging from a mild self-limited disease, with interstitial edema in the pancreas, to a severe disease with extensive necrosis [1]
The clinical course of an attack of AP varies from a short period of hospitalization with supportive care to prolonged hospitalization and admittance to an intensive care unit (ICU) because of the development of systemic inflammatory response syndrome (SIRS), multiorgan failure (MOF), and septic complications
enteral nutrition (EN) was given for more than seven days in all the six papers (Table 4). This meta-analysis shows that EN, compared with parenteral nutritional (PN), has important beneficial effects in patients with predicted severe acute pancreatitis, notably, clinically relevant, and statistically significant risk reduction in pancreatitis-related complications, non-pancreatitis-related complications, multipleorgan failure (MOF), surgery intervention, and mortality

Summary

Introduction

Acute pancreatitis is an inflammatory process that presents different severity degrees, ranging from a mild self-limited disease, with interstitial edema in the pancreas, to a severe disease with extensive necrosis [1]. Severe AP with its related systemic inflammatory response (SIR) causes increased metabolic demands and may progress to multiorgan disease (MOD). Recurrent attacks of alcoholic AP, were not associated with cigarette smoking [3] but occurred less frequently in those who had repeated 6-month counselling sessions (to encourage sobriety) compared with a single session (8% versus 21%, P = .042) [4]. These data reinforce the common sense approach of encouraging drinking cessation. In about 15% to 20% of patients, AP progresses to a severe illness with a prolonged disease course These severely ill patients may develop organ failure and/or local complications such as pancreatic necrosis. In addition to cost and the risk of catheter-related sepsis, TPN may worsen the inflammatory process, lead to metabolic and electrolyte disturbances, alter gut barrier due to increased intestinal permeability, and develop sepsis and multiple organ failure [17]

Methods

Results

Conclusion