Efficacy comparisons of enteral nutrition and parenteral nutrition in patients with severe acute pancreatitis: a meta-analysis from randomized controlled trials.

Ping Wu,Weijia Sun,Liang Li

doi:10.1042/bsr20181515

Abstract

We conducted a comprehensive analysis to evaluate the treatment efficacy and safety of enteral nutrition (EN) and parenteral nutrition (PN) in severe acute pancreatitis (SAP) patients, and to provide a basis for their evidence based application in a clinical setting. We conducted a systematic online search of the PubMed, Web of Science, Wanfang, and China National Knowledge Infrastructure databases, from their inception to November 2017. Studies were subjected to further screening if they met the inclusion/exclusion criteria. Eleven studies were subjected to qualitative and quantitative synthesis; these included a total of 562 patients (281 for EN and 281 for PN). No significant heterogeneity across studies was found. The results indicated that EN can significantly decrease the mortality rate (relative risk [RR] = 0.43, 95% confidence interval [CI]: 0.23–0.78, P=0.006), and lowers the risk of infection and complications (RR = 0.53, 95% CI: 0.39–0.71, P=0.000) more so than does PN. The EN group had a similar risk of multiple organ failure (MOF) compared with the PN group (RR = 0.63, 95% CI: 0.39–1.02, P=0.059). The use of EN was also found to significantly reduce mean hospitalization time (mean difference = −2.93, 95% CI: −4.52–1.34, P=0.000). No publication bias was found. Our meta-analysis suggested that EN, but not PN, significantly reduced the risk of mortality, infection, and complications for patients with SAP. EN support also decreased the rate of MOF and surgical intervention. EN is recommended as an initial treatment option for patients with SAP.

Highlights

Acute pancreatitis is a common abdominal disease that can be divided into mild and severe acute pancreatitis (SAP) [1]
The results indicated that enteral nutrition (EN) can significantly decrease the overall mortality rate compared with parenteral nutrition (PN) (RR = 0.43, 95% confidence interval (CI): 0.23–0.78, P=0.006, Figure 2)
The results indicated that the EN groups had a lower rate of infection and complication than PN groups (RR = 0.53, 95% CI: 0.39–0.71, Figure 3)

Summary

Introduction

Acute pancreatitis is a common abdominal disease that can be divided into mild and severe acute pancreatitis (SAP) [1]. SAP is often accompanied by systemic inflammatory response syndrome (SIRS), which is a serious inflammatory response that significantly increases catabolism and energy consumption [3] This often results in rapid loss of reserve nutrients, imbalances in acid–base regulation, and loss of water and electrolytes in the body. These metabolic abnormalities, in conjunction with failure to receive timely treatment, may lead to multiple organ failure (MOF) involving the heart, lungs, and kidneys This further worsens the prognosis and overall survival rate of patients with SAP [4,5]. Some studies have found that EN support for patients with SAP is similar to intestinal nutrition in terms of its ability to reduce mortality and infection rates. We conducted a comprehensive analysis to evaluate the treatment efficacy and safety of EN and PN in SAP, and to provide an evidence base for their use in the clinical setting

Literature search

Results

Discussion