A Meta-Analysis of Enteral Nutrition and Total Parenteral Nutrition in Patients with Acute Pancreatitis

Abstract

Objective. To analyze the effect of total parenteral nutrition (TPN) and enteral nutrition (EN) in patients with acute pancreatitis. Methods. Randomized controlled trials of TPN and EN in patients with acute pancreatitis were searched in NCBI and CBM databases and The Cochrane Controlled Trials Register. Six studies were enrolled into the analysis, and the details about the trial designs, characters of the subjects, results of the studies were reviewed by two independent authors and analyzed by STATA 11.0 software. Results. Compared with TPN, EN was associated with a significantly lower incidence of pancreatic infection complications (RR = 0.556, 95% CI 0.436∼0.709, P = .000), MOF (RR = 0.395, 95% CI 0.272∼0.573, P = .003), surgical interventions (RR = 0.556, 95% CI 0.436∼0.709, P = .000), and mortality (RR = 0.426, 95% CI 0.238∼0.764, P = .167). There was no statistic significance in non-pancreatitis-related complications (RR = 0.853, 95% CI 0.490∼1.483, P = .017). However, EN had a significantly higher incidence of non-infection-related complications (RR = 2.697, 95% CI 1.947∼3.735, P = .994). Conclusion. EN could be the preferred nutrition feeding method in patients with acute pancreatitis.

Early enteral nutrition improves intestinal immune barrier in a rat model of severe acute pancreatitis

“…Several clinical studies have demonstrated that EEN can produce better clinical outcomes than TPN . Consistent with these studies, we found that EEN treatment resulted in a higher survival rate in SAP rats compared with TPN, accompanied by a decreased in the serum amylase content.…”

“…However, several studies have shown that TPN is associated with disrupted gut‐barrier function, comprised immune system, and increased bacterial translocation . In contrast, increasing evidence has shown that enteral nutrition (EN) improves overall patient outcome compared with TPN . Furthermore, early EN (EEN) has been reported to be associated with reduced complications and improved clinical outcomes in AP patients .…”

Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy: a meta-analysis

“…After surgery small bowel recovers its ability to absorb nutrients almost immediately . There are evidences that the early enteral feeding has been shown to preserve the integrity of gut mucosa and to keep up its immunological function . After the esophagectomy, the intestinal ischemia or intestinal paralysis and lack of the intestinal stimulation and oral nutrition can increase the atrophy, damage the permeability of intestinal mucosa.…”

“…4 There are evidences that the early enteral feeding has been shown to preserve the integrity of gut mucosa and to keep up its immunological function. [27][28][29] After the esophagectomy, the intestinal ischemia or intestinal paralysis and lack of the intestinal stimulation and oral nutrition can increase the atrophy, damage the permeability of intestinal mucosa. As a result, the gut bacteria and endotoxins can easily migrate and enter the blood stream.…”

Nutrition in acute pancreatitis: a review

“…In two following meta-analysis these conclusions proved to be correct [19,20]. In the latest meta-analysis published by Heming in 2012 [21], six studies were reviewed comparing EN vs PN and it becomes clear that nutritional support with EN decreases pancreatic complications (infections, abscesses and necrosis), mortality rate and multi-organ failure. Concerning infective complications with a non-pancreatic origin, including pneumonia, urinary tract infection and catheter infection, there were not significant differences.…”