Impact of nutritional support routes on mortality in acute pancreatitis: A network meta-analysis of randomized controlled trials.

Abstract

Nutritional administration in acute pancreatitis (AP) management has sparked widespread discussion, yet contradictory mortality results across meta-analyses necessitate clarification. The optimal nutritional route in AP remains uncertain. Therefore, this study aimed to compare mortality among nutritional administration routes in patients with AP using consistency model. This study searched four major databases for relevant randomized controlled trials (RCTs). Two authors independently extracted and checked data and quality. Network meta-analysis was conducted for estimating risk ratios (RRs) with 95% confidence interval (CI) based on random-effects model. Subgroup analyses accounted for AP severity and nutrition support initiation. A meticulous search yielded 1185 references, with 30 records meeting inclusion criteria from 27 RCTs (n=1594). Pooled analyses showed the mortality risk reduction associated with nasogastric (NG) (RR=0.34; 95%CI: 0.16-0.73) and nasojejunal (NJ) feeding (RR=0.46; 95%CI: 0.25-0.84) in comparison to nil per os. Similarly, NG (RR=0.45; 95%CI: 0.24-0.83) and NJ (RR=0.60; 95%CI: 0.40-0.90) feeding also showed lower mortality risk than total parenteral nutrition. Subgroup analyses, stratified by severity, supported these findings. Notably, the timing of nutritional support initiation emerged as a significant factor, with NJ feeding demonstrating notable mortality reduction within 24 and 48h, particularly in severe cases. For severe AP, both NG and NJ feeding appear optimal, with variations in initiation timings. NG feeding does not appear to merit recommendation within the initial 24h, whereas NJ feeding is advisable within the corresponding timeframe following admission. These findings offer valuable insights for optimizing nutritional interventions in AP.