A systematic review and meta-analysis of the effect of total parenteral nutrition and enteral nutrition on the prognosis of patients with acute pancreatitis

Abstract

Background: Nutritional support is very important in the treatment of severe acute pancreatitis, this study aimed to investigate the effect of total parenteral nutrition (TPN) and enteral nutrition (TEN) on the prognosis of patients with acute pancreatitis. Methods:The databases of PubMed, Embase, Cochrane Library, and Ovid were searched using the keywords acute pancreatitis, enteral nutrition, and parenteral nutrition to obtain the reports of randomized controlled trials (RCTs) published after 2000. After screening the articles according to the inclusion criteria, risk of bias of the included literatures was evaluated using the Cochrane Handbook for Systematic Reviews.The software RevMan 5.3.5 was used for analysis and the creation of a forest plot and funnel plot.Results: A total of 488 literatures were preliminarily searched in this study, from which 10 articles were included into the final quantitative analysis, involving a total of 699 participants. A total of 6 literatures (n=329 participants) reported the infection rate indicators. The obtained statistic value [odds ratio (OR) =0.25, 95% confidence interval (CI): 0.10 to 0.62] showed TEN had less infection rate that TPN (P=0.003). A total of 8 studies (654 participants) reported the incidence rate indicators of multiple organ failure rate indicator, the obtained statistic value (OR =0.50, 95% CI: 0.24 to 1.08) showed no statistical difference between TEN and TPN (P>0.05). A total of 7 studies (550 participants) reported the mortality indicators. The obtained statistic value (OR =0.59, 95% CI: 0.37 to 0.94) showed TEN had less mortality than TPN (P=0.03). A total of 3 studies reported the length of hospital stay indicators. The obtained statistic value [mean difference (MD) −4.18, 95% CI: −5.07 to −3.30] showed the length of hospital stay for TEN was shorter that TPN (P<0.001).Discussion: Compared with TPN, TEN can reduce the incidence of infection, reduce the development of multiple organ failure, reduce mortality, and shorten the length of hospital stay in patients with severe acute pancreatitis (SAP). However, attention should be paid to prevent the occurrence of complications during the implementation of nutritional intervention.

Parenteral Nutrition Overview

“…Given these data, both the American Gastroenterological Association and ESPEN recommend that EN should be preferred to PN in patients with AP and an intolerance of oral feeding [ 114 , 127 ]. A more recent study has also explored this topic and reached the same conclusions [ 128 ]. PN is therefore only recommended in patients with AP who do not tolerate EN or who are unable to tolerate targeted nutritional requirements, or if contraindications for EN exist.…”

Nutrition in Pancreatic Diseases: A Roadmap for the Gastroenterologist

“…In patients unable to tolerate ON, EN is preferred to PN and should be started early, within 24-72 h of admission according to energy requirements calculated through simplistic formulas (25-30 kcal/kg/day), published predictive equations, or indirect calorimetry [20,21]. Numerous studies have demonstrated that early initiation of EN in patients with AP is associated with significantly improved outcomes compared to PN [21][22][23].…”

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

“…For example, the International Association of Pancreatology guideline in 2013 emphasized the significance of enteral feeding via NG or NJ over TPN in predicted severe AP [2], a recommendation consistent with subsequent guidelines [3,4]. Additional investigation is justified to determine the most effective nutritional strategies, considering the insufficiency and inconsistencies present in prior evidence, even with existing syntheses addressing this topic [5][6][7][8][9][10][11][12][13][14][15]. For instance, several studies lack differentiation between NG and NJ feeding [8,9,11,13,14], and some others do not take the timing of initiation into consideration [5,6,10,12,15].…”

“…Additional investigation is justified to determine the most effective nutritional strategies, considering the insufficiency and inconsistencies present in prior evidence, even with existing syntheses addressing this topic [5][6][7][8][9][10][11][12][13][14][15]. For instance, several studies lack differentiation between NG and NJ feeding [8,9,11,13,14], and some others do not take the timing of initiation into consideration [5,6,10,12,15]. Despite some syntheses suggesting the advantages of enteral feeding over TPN, recent evidence from American Gastroenterological Association indicates that enteral feeding does not significantly reduce the risk of mortality in comparison to TPN for patients with AP [12].…”