Meta-analysis of early nutrition: the benefits of enteral feeding compared to a nil per os diet not only in severe, but also in mild and moderate acute pancreatitis

Péter Hegyi,Nelli Farkas,Katalin Marta

doi:10.1016/j.pan.2017.07.061

Péter Hegyi, Nelli Farkas + Show 1 more

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https://doi.org/10.1016/j.pan.2017.07.061

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Journal: Pancreatology	Publication Date: Sep 1, 2017
Citations: 42	License type: cc-by

Affiliation: University of Pecs, Institute of Biophysics

Abstract

The recently published guidelines for acute pancreatitis (AP) suggest that enteral nutrition (EN) should be the primary therapy in patients suffering from severe acute pancreatitis (SAP); however, none of the guidelines have recommendations on mild and moderate AP (MAP). A meta-analysis was performed using the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). The following PICO (problem, intervention, comparison, outcome) was applied: P: nutrition in AP; I: enteral nutrition (EN); C: nil per os diet (NPO); and O: outcome. There were 717 articles found in Embase, 831 in PubMed, and 10 in the Cochrane database. Altogether, seven SAP and six MAP articles were suitable for analyses. In SAP, forest plots were used to illustrate three primary endpoints (mortality, multiorgan failure, and intervention). In MAP, 14 additional secondary endpoints were analyzed (such as CRP (C-reactive protein), WCC (white cell count), complications, etc.). After pooling the data, the Mann-Whitney U test was used to detect significant differences. Funnel plots were created for testing heterogeneity. All of the primary endpoints investigated showed that EN is beneficial vs. NPO in SAP. In MAP, all of the six articles found merit in EN. Analyses of the primary endpoints did not show significant differences between the groups; however, analyzing the 17 endpoints together showed a significant difference in favor of EN vs. NPO. EN is beneficial compared to a nil per os diet not only in severe, but also in mild and moderate AP.

Highlights

Acute pancreatitis (AP) is a severe inflammatory disease with high mortality [1]
Silidnceanthde mresoudltesrate AP as well.in basic science have demonstrated the crucial role of energy breakdown in the early phase of AP, in this study we performed a systemic review of the literature followed by a meta-analysis to
Analyses of the secondary endpoints in the articles demonstrated that enteral feeding could be beneficial compared to a nil per os diet in mild and moderate AP as well

Summary

Introduction

Acute pancreatitis (AP) is a severe inflammatory disease with high mortality [1]. Despite the extensive research in the field, no specific therapy is available to treat AP [2]. 2. Resuulntdserstand whether enteral feeding should be the primary therapy in severe AP, but in mild and moderate AP as well. Seven out of seven articles contained analyzable data on mortal [16,17,18,19,20,21,22] Risk differences and CI were2.c1a. SSuummmmaarryy ooff tthhee uunniiffoorrmm ddaattaa--ppooiinntt ssyysstteemm iinn MMAAPP. DDuuee ttoo tthhee llooww aammoouunntt ooff ddaattaa,, 33 pprriimmaarryy eennddppooiinnttss aanndd 1144 sseeccoonnddaarryy eennddppooiinnttss wweerree ccoolllleecctteedd ffoorr MMAAPP. We wanted to systematically review the current literature to understand the beneficial effects of early enteral nutrition vs the nil per os diet both in SAP and MAP. In SAP, the amount of data was sufficient to prove the beneficial effects of enteral feeding. Enteral feeding was clearly beneficial for MOF and intervention and showed beneficial tendency for

Discussion

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Statistical Analyses

Conclusions