Abstract
BackgroundEnteral nutrition is increasingly advocated in the treatment of acute pancreatitis, but its timing is still controversial. The aim of this meta-analysis was to find out the feasibility of early enteral nutrition within 48 hours of admission and its possible advantages.Methods and FindingsWe searched PubMed, EMBASE Databases, Web of Science, the Cochrane library, and scholar.google.com for all the relevant articles about the effect of enteral nutrition initiated within 48 hours of admission on the clinical outcomes of acute pancreatitis from inception to December 2012. Eleven studies containing 775 patients with acute pancreatitis were analyzed. Results from a pooled analysis of all the studies demonstrated that early enteral nutrition was associated with significant reductions in all the infections as a whole (OR 0.38; 95%CI 0.21–0.68, P<0.05), in catheter-related septic complications (OR 0.26; 95%CI 0.11–0.58, P<0.05), in pancreatic infection (OR 0.49; 95%CI 0.31–0.78, P<0.05), in hyperglycemia (OR 0.24; 95%CI 0.11–0.52, P<0.05), in the length of hospitalization (mean difference −2.18; 95%CI −3.48−(−0.87); P<0.05), and in mortality (OR 0.31; 95%CI 0.14–0.71, P<0.05), but no difference was found in pulmonary complications (P>0.05). The stratified analysis based on the severity of disease revealed that, even in predicted severe or severe acute pancreatitis patients, early enteral nutrition still showed a protective power against all the infection complications as a whole, catheter-related septic complications, pancreatic infection complications, and organ failure that was only reported in the severe attack of the disease (all P<0.05).ConclusionEnteral nutrition within 48 hours of admission is feasible and improves the clinical outcomes in acute pancreatitis as well as in predicted severe or severe acute pancreatitis by reducing complications.
Highlights
Acute pancreatitis (AP) presents in about 80% of patients as a course without serious morbidities and with a low mortality rate [1]
Selection Criteria Studies that were included must fulfill the following criteria: (i) design: available randomized comparative trials (RCT) or retrospective comparative trials fully reported with detailed information; (ii) population: patients with AP; (iii) intervention: enteral nutrition (EN) initiated within 48 hours of admission and controlled by total parenteral nutrition (TPN) or EN outside 48 hours
Data Extraction and Management The following information was obtained from the included studies: the first author, year of publication, the starting time of EN, the severity of AP, the number of participants, the EN route, design features of the studies, the number of all the infections as a whole, catheter-related septic complications, pancreatic infection, hyperglycemia, pulmonary complication, organ failure (OF), death, and the length of hospitalization (LOH) of both early EN group and the control group
Summary
Acute pancreatitis (AP) presents in about 80% of patients as a course without serious morbidities and with a low mortality rate [1]. Once organ failure (OF), which is thought to be one of the consequences of systematic inflammation response syndrome (SIRS), or infected pancreatic necrosis occurs, mortality raises from 3% to 30% and 32% respectively [2]. It is well demonstrated that the damage of gut barrier is responsible for the initiation of SIRS and sepsis and associated with the infected pancreatic necrosis. The bacterial flora in the intestine gains access to the systemic circulation through the damaged gut barrier, which causes sepsis or infected pancreatic necrosis in the very early phase of the disease. Enteral nutrition is increasingly advocated in the treatment of acute pancreatitis, but its timing is still controversial The aim of this meta-analysis was to find out the feasibility of early enteral nutrition within 48 hours of admission and its possible advantages
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