BMJ  2004;328:1407 (12 June), doi:10.1136/bmj.38118.593900.55 (published 2 June 2004)

Paper

Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis

¹ Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA, ² Methodist Research Institute, Indianapolis, IN 46202, USA

Objective To compare the safety and clinical outcomes of enteral and parenteral nutrition in patients with acute pancreatitis.

Data sources Medline, Embase, Cochrane controlled trials register, and citation review of relevant primary and review articles.

Study selection Randomised controlled studies that compared enteral nutrition with parenteral nutrition in patients with acute pancreatitis. From 117 articles screened, six were identified as randomised controlled trials and were included for data extraction.

Data extraction Six studies with 263 participants were analysed. Descriptive and outcome data were extracted. Main outcome measures were infections, complications other than infections, operative interventions, length of hospital stay, and mortality. The meta-analysis was performed with the random effects model.

Data synthesis Enteral nutrition was associated with a significantly lower incidence of infections (relative risk 0.45; 95% confidence interval 0.26 to 0.78, P = 0.004), reduced surgical interventions to control pancreatitis (0.48, 0.22 to 1.0, P = 0.05), and a reduced length of hospital stay (mean reduction 2.9 days, 1.6 days to 4.3 days, P < 0.001). There were no significant differences in mortality (relative risk 0.66, 0.32 to 1.37, P = 0.3) or non-infectious complications (0.61, 0.31 to 1.22, P = 0.16) between the two groups of patients.

Conclusions Enteral nutrition should be the preferred route of nutritional support in patients with acute pancreatitis.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related Articles

Enteral nutrition is better than parenteral in acute pancreatitis
BMJ 2004 328: 0. [Full Text]

Do mistakes matter?

Kamran Abbasi
BMJ 2004 328: 0. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Fuentes-Orozco, C., Cervantes-Guevara, G., Mucino-Hernandez, I., Lopez-Ortega, A., Ambriz-Gonzalez, G., Gutierrez-de-la-Rosa, J. L., Gomez-Herrera, E., Hermosillo-Sandoval, J. M., Gonzalez-Ojeda, A. (2008). L-Alanyl-L-Glutamine-Supplemented Parenteral Nutrition Decreases Infectious Morbidity Rate in Patients With Severe Acute Pancreatitis. JPEN J Parenter Enteral Nutr 32: 403-411 [Abstract] [Full text]  
• Carreazo, N. Y, Ugarte, K., Bada, C. (2008). When should we start oral intake in children with severe acute pancreatitis?. Evid. Based Nurs. 11: 39-40 [Full text]  
• Carreazo P, N. Y, Ugarte R, K., Bada M, C. (2008). When should we start oral intake in children with severe acute pancreatitis?. Evid. Based Med. 13: 4-5 [Full text]  
• Whitcomb, D. C. (2006). Acute Pancreatitis. NEJM 354: 2142-2150 [Full text]  
• Campbell, S. J., Marks, S. L., Yoshimoto, S. K., Riel, D. L., Fascetti, A. J. (2006). Complications and outcomes of one-step low-profile gastrostomy devices for long-term enteral feeding in dogs and cats.. Journal of the American Animal Hospital Association 42: 197-206 [Abstract] [Full text]  
• McClave, S. A., Chang, W.-K., Dhaliwal, R., Heyland, D. K. (2006). Nutrition Support in Acute Pancreatitis: A Systematic Review of the Literature. JPEN J Parenter Enteral Nutr 30: 143-156 [Abstract] [Full text]  
• O'Keefe, S. J. D., Lee, R. B., Li, J., Zhou, W., Stoll, B., Dang, Q. (2006). Trypsin and splanchnic protein turnover during feeding and fasting in human subjects. Am. J. Physiol. Gastrointest. Liver Physiol. 290: G213-G221 [Abstract] [Full text]  
• Tiengou, L.-E., Gloro, R., Pouzoulet, J., Bouhier, K., Read, M.-H., Arnaud-Battandier, F., Plaze, J.-M., Blaizot, X., Dao, T., Piquet, M.-A. (2006). Semi-Elemental Formula or Polymeric Formula: Is There a Better Choice for Enteral Nutrition in Acute Pancreatitis? Randomized Comparative Study. JPEN J Parenter Enteral Nutr 30: 1-5 [Abstract] [Full text]  
• Pritchard, C., Duffy, S., Edington, J., Pang, F. (2006). Enteral Nutrition and Oral Nutrition Supplements: A Review of the Economics Literature. JPEN J Parenter Enteral Nutr 30: 52-59 [Abstract] [Full text]  
• Lipman, T. O. (2006). Beware of Big Gifts in Small Studies. JPEN J Parenter Enteral Nutr 30: 66-68 [Full text]  
• Koretz, R. L., Lipman, T. O. (2005). Update in Gastroenterology and Hepatology. ANN INTERN MED 143: 347-354 [Full text]  
• O'Keefe, S. J. D., Lee, R. B., Li, J., Stevens, S., Abou-Assi, S., Zhou, W. (2005). Trypsin secretion and turnover in patients with acute pancreatitis. Am. J. Physiol. Gastrointest. Liver Physiol. 289: G181-G187 [Abstract] [Full text]  
• Lipman, T. O. (2005). When is a Controversy Not a Controversy? Escaping Never-Never Land. Nutr Clin Pract 20: 291-293 [Full text]  
• Binnekade, J. M (2005). Review: enteral nutrition reduces infections, need for surgical intervention, and length of hospital stay more than parenteral nutrition in acute pancreatitis. Evid. Based Nurs. 8: 19-19 [Full text]  
• (2004). Other articles noted. Evid. Based Med. 9: 191-192 [Full text]  
• (2004). Use Enteral Nutrition for Acute Pancreatitis. JWatch General 2004: 5-5 [Full text]  

Rapid Responses:

Read all Rapid Responses

Critical illness polyneuropathy is the true spectrum for patients with acute pancreatitis in parenteral nutrition.

Vincenzo Fodale, et al.
bmj.com, 19 Jun 2004 [Full text]

Acute Pancreatitis; Enteral is not always best.

David JW Knight
bmj.com, 30 Jun 2004 [Full text]

The urgent need to make enteral and parenteral nutrition in acute pancreatitis redundant.

Richard G Fiddian-Green
bmj.com, 30 Jun 2004 [Full text]

Bias acting in favour of the outcome

Alvaro Sanabria
bmj.com, 14 Jul 2004 [Full text]