Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: Results of a randomized prospective trial

Kalfarentzos, Fotis; Kehagias, J.; Mead, Nancy; Kokkinis, K.; Gogos, Charalambos

doi:10.1046/j.1365-2168.1997.02851.x

Cited by 302 publications

(189 citation statements)

References 26 publications

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“…Furthermore, the concurrent administration of antibiotics might have a confounding effect, with almost all patients in our systematic review receiving antibiotics, which are known to increase the risk of diarrhoea during EN (36,37) . In addition, a number of RCT have demonstrated that EN in predicted severe acute pancreatitis is associated with the reduced blood glucose concentrations (25,26) , which in themselves may accelerate intestinal motility (41,42) and thus exacerbate diarrhoea in those receiving EN.…”

Section: Discussionmentioning

confidence: 99%

Comparison of complications attributable to enteral and parenteral nutrition in predicted severe acute pancreatitis: a systematic review and meta-analysis

Petrov

Whelan

2010

Br J Nutr

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Enteral nutrition (EN) reduces infectious complications and mortality compared with parenteral nutrition (PN) in patients with predicted severe acute pancreatitis. However, to date the complications attributable to the administration of EN and PN in this patient group have not been comprehensively studied. The aim of the study was to systematically review the complications related to the use of nutrition in patients with predicted severe acute pancreatitis receiving EN v. PN. The Cochrane Library, MEDLINE and Scopus were searched. Randomised controlled trials (RCT) of EN v. PN in predicted severe acute pancreatitis were selected. Pooled estimates of complications were expressed as OR with corresponding 95 % CI. Data from five RCT were meta-analysed. Diarrhoea occurred in six of ninety-two (7 %) patients receiving PN and twenty-four of eighty-two (29 %) patients receiving EN (OR 0·20; 95 % CI 0·09, 0·43; P,0·001). Hyperglycaemia developed in twenty-one of ninety-two (23 %) patients receiving PN and nine of eighty-two (11 %) receiving EN (OR 2·59; 95 % CI 1·13, 5·94; P¼ 0·03). Given a significant reduction in infectious complications and mortality associated with the use of EN over PN that has been consistently demonstrated in previous studies, the former should be the treatment of choice in acute pancreatitis. Further clinical studies should investigate the strategies to mitigate the complications of enteral tube feeding in patients with acute pancreatitis.

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Section: Discussionmentioning

confidence: 99%

Comparison of complications attributable to enteral and parenteral nutrition in predicted severe acute pancreatitis: a systematic review and meta-analysis

Petrov

Whelan

2010

Br J Nutr

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“…Thirty-three articles (21 articles containing patients suffering from SAP as well as 12 articles with MAP patients) were selected. They contained two nonrandomized and 31 randomized controlled clinical trials (Table 2) [16][17][18][19][20][21][22][23][24][25][26][27]29,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50]. Finally, statistical analyses were performed on data from articles where both EN and NPO groups were presented, the trial was randomized, and the relevant data were available.…”

Section: Inclusions and Exclusionsmentioning

confidence: 99%

“…Seven out of seven articles contained analyzable data on mortal [16][17][18][19][20][21][22] Risk differences and CI were calculated in each article to analyze the effects of EN compared to the NPO nutrition. The calculated average risk difference (RD) was −0.050 (lower limit (LI): −0.134; upper limit (UI): 0.035; p-value: 0.249) (Figure 1).…”

Section: Severe Acute Pancreatitis (Sap) Groupmentioning

confidence: 99%

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

2017

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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.

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“…Windsor et al (1998) randomized thirty-four patients with acute pancreatitis to either TPN or EN and did not observe any difference in incidence of sepsis, length of hospital stay, computed tomography score or organ failure. Kalfarentzos et al (1997) randomized thirty-eight patients to either EN or TPN and showed that patients receiving TPN had a higher incidence of sepsis but did not increase the stay in the intensive care unit or the hospital. In this study, also, TPN did not increase the need for antibiotics or ventilator support.…”

Section: Pancreatitismentioning

confidence: 99%

Enteral and parenteral nutrition: evidence-based approach

Jeejeebhoy

2001

Proc. Nutr. Soc.

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Nutrition support for patients in hospital has become an essential form of therapy. Total parenteral nutrition (TPN) was the preferred way of giving nutrition to hospital patients for many years but enteral nutrition (EN) is now the preferred route. EN is believed to promote gut function and prevent translocation of intestinal bacteria, thus reducing the incidence of sepsis in critically ill patients. In consequence, the use of TPN has been discouraged as a dangerous form of therapy. Critical review of the data suggests that in the human subject TPN does not cause mucosal atrophy or increase translocation of bacteria through the small intestine. However, overfeeding, which is easy with TPN, can explain the results of studies which have shown that TPN increases sepsis. Furthermore, the risks of TPN-induced complications have been exaggerated. When there is risk of malnutrition and EN is not tolerated, or there is gut failure, TPN is an equally effective and safe alternative.

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Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: Results of a randomized prospective trial

Abstract: This study suggests that early enteral nutrition should be used preferentially in patients with severe acute pancreatitis.

Cited by 302 publications

References 26 publications

Comparison of complications attributable to enteral and parenteral nutrition in predicted severe acute pancreatitis: a systematic review and meta-analysis

Comparison of complications attributable to enteral and parenteral nutrition in predicted severe acute pancreatitis: a systematic review and meta-analysis

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

Enteral and parenteral nutrition: evidence-based approach

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