Immediate enteral nutrition can accelerate recovery and be safe in mild acute pancreatitis: A meta-analysis of randomized controlled trials

Guo, Qinghua; Tian, Xinyi; Qin, Yuelan; Han, Xiaotong; Wang, Weihong

doi:10.1016/j.heliyon.2022.e08852

Cited by 11 publications

(15 citation statements)

References 37 publications

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“…Finally, both studies do not mention the actual caloric intake per day, which is a better reflection of the nutritional status. Two recent meta-analyses confirmed that early diet resumption is associated with short hospital stay [14,15].…”

Section: Nutritionmentioning

confidence: 96%

Update on the management of acute pancreatitis

Berg

Boermeester

2023

Current Opinion in Critical Care

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Purpose of reviewThis review provides insight into the recent advancements in the management of acute pancreatitis.Recent findingsModerate fluid resuscitation and Ringer's lactate has advantages above aggressive fluid resuscitation and normal saline, respectively. A normal “on-demand” diet has a positive effect on recovery from acute pancreatitis and length of hospital stay. A multimodal pain management approach including epidural analgesia might reduce unwarranted effects of opiate use. A more targeted use of antibiotics is starting to emerge. Markers such as procalcitonin may be used to limit unwarranted antibiotic use. Conversely, many patients with infected necrotizing pancreatitis can be treated with only antibiotics, although the optimal choice and duration is unclear. Delay of drainage as much as is possible is advised since it is associated with less procedures. If drainage is required, clinicians have an expanding arsenal of interventional options to their disposal such as the lumen-apposing metal stent for transgastric drainage and (repeated) necrosectomy. Immunomodulation using removal of systemic cytokines or anti-inflammatory drugs is an attractive idea, but up to now the results of clinical trials are disappointing. No additional preventive measures beside non-steroidal anti-inflammatory drugs (NSAIDs) can be recommended for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis.SummaryMore treatment modalities that are less invasive became available and a trend towards less aggressive treatments (fluids, starvation, interventions, opiates) of acute pancreatitis is again emerging. Despite recent advancements, the pathophysiology of specific subgroup phenotypes is still poorly understood which reflects the disappointing results of pharmacological and immunomodulatory trials.

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Section: Nutritionmentioning

confidence: 96%

Update on the management of acute pancreatitis

Berg

Boermeester

2023

Current Opinion in Critical Care

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“…enteral nutrition (various definitions) [mean difference (95% confidence interval, 95% CI): 2.57 (0.4-4.72); P ¼ 0.02] [13].…”

Section: Key Pointsmentioning

confidence: 99%

“…Finally, a recent meta-analysis of five RCTs ( n = 372) showed that immediate enteral nutrition defined as feeding initiated just after admission was associated with a statistically significant decrease in the length of hospitalization compared with early enteral nutrition (various definitions) [mean difference (95% confidence interval, 95% CI): 2.57 (0.4–4.72); P = 0.02] [13].…”

Section: Introductionmentioning

confidence: 99%

Nutrition in acute pancreatitis: when, what and how

Fostier

Arvanitakis

Gkolfakis

2022

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewThis review intends to discuss recently available evidence in three topics related to nutrition in patients with acute pancreatitis, namely timing of refeeding, type of nutritional therapy and its route of administration.Recent findingsRecent lines of research confirm that early oral feeding leads to shorter length of stay, fewer complications and lower costs in patients with acute pancreatitis. Moreover, early (<48 h) enteral nutrition led to decreased hospital mortality in patients with mild and severe acute pancreatitis; thus, in case of intolerance to oral feeding or severe disease, nutritional therapy should be offered within 24–72 h. Furthermore, enteral nutrition should be preferred against parenteral nutrition, as it is related to shorter length of stay and less complications, while initial data bring to light the potential role of the soluble dietary fibre polydextrose as an agent that could lead to faster achievement of energy goal with concomitant lower rates of feeding intolerance. Finally, enteral nutrition can be administered through gastric or jejunal feeding, depending on digestive tolerance, whereas latest data also address the safety of percutaneous gastrostomy with a jejunal extension for enteral nutrition administration. However, more data about its real benefit are warranted.SummaryAccumulating evidence confirms the importance of early oral refeeding or early administration of enteral nutrition as vital parts of the armamentarium for the management of patients with acute pancreatitis.

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“…[1] Additionally, some authors recently reported that immediate oral feeding is feasible, safe and may accelerate recovery. [5,7–9]…”

Section: Introductionmentioning

confidence: 99%

“…[1] Additionally, some authors recently reported that immediate oral feeding is feasible, safe and may accelerate recovery. [5,[7][8][9] Accordingly, we designed the present clinical trial to assess whether home monitoring is effective, safe and non-inferior to hospitalization for managing mild AP.…”

Section: Introductionmentioning

confidence: 99%

Home monitoring vs hospitalization for mild acute pancreatitis. A pilot randomized controlled clinical trials

Sorribas,

Carnaval,

Peláez

et al. 2023

Medicine

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Introduction: Acute pancreatitis is a high-incidence benign disease. In 2009, it was the second highest cause of total hospital stays, the largest contributor to aggregate costs (approximately US$ 7000.00 per hospitalization), and the fifth leading cause of in-hospital deaths in the United States. Although almost 80% of acute pancreatitis cases are mild (usually requiring short-term hospitalization and without further complications), severe cases can be quite challenging.Classifications, scores, and radiological criteria have been developed to predict disease severity and outcome accurately; however, in-hospital care remains of widespread use, regardless of disease severity. A recent Turkish study reported that mild acute pancreatitis can be effectively and safely managed with home monitoring. Although the optimal timing for oral refeeding remains controversial and could cast some doubt on the feasibility of home monitoring, some guidelines already advocate for starting it within 24 hours.The present clinical trial aims to assess whether home monitoring is effective, safe and non-inferior to hospitalization for managing mild acute pancreatitis.Methods: This will be a multicenter open-label randomized (1:1) controlled clinical trial to assess the efficacy and safety of home monitoring compared to in-hospital care for mild acute pancreatitis. All patients coming to the emergency department with suspected acute pancreatitis will be screened for enrollment. The main variable will be treatment failure (Yes/No) within the first 7 days after randomization.Discussion: Acute pancreatitis implies a high economic burden in healthcare systems worldwide. Recent evidence suggests that mild disease can be safely and effectively treated with home monitoring. This approach may produce considerable cost savings and positively impact patients' quality of life. We expect the results to show that home monitoring is effective and not inferior to hospitalization for managing mild acute pancreatitis and that the economic costs are lower, kickstarting similar trials throughout the world, optimizing the use of limited healthcare budgets, and improving patients' quality of life.Abbreviations: AP = acute pancreatitis, BISAP = Bedside Index for Severity in Acute Pancreatitis, DSMC = Data Safety Monitoring Committee, ER = emergency room, HRQoL = health-related quality of life, QoL = quality of life, VAS = Visual Analogue Scale.

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Immediate enteral nutrition can accelerate recovery and be safe in mild acute pancreatitis: A meta-analysis of randomized controlled trials

Cited by 11 publications

References 37 publications

Update on the management of acute pancreatitis

Update on the management of acute pancreatitis

Nutrition in acute pancreatitis: when, what and how

Home monitoring vs hospitalization for mild acute pancreatitis. A pilot randomized controlled clinical trials

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