Parenteral versus enteral nutrition for pancreatic fistula: A systematic review and meta-analysis.

Abstract

University Background: Approximately 10-40% of patients undergoing pancreatectomy develop postoperative pancreatic fistula (POPF). Currently, conservative management focusing on nutritional optimization is widely applied in the setting of POPF. However, there is no consensus on the most effective route for administration of nutrients in this setting. We aimed to compare the efficacy of parenteral nutrition (control) versus enteral nutrition (intervention) in the rate of POPF closure. Methods: Medline, EMBASE, CENTRAL, and Web of Science databases were searched for randomized controlled trials comparing enteral to parenteral nutrition in the conservative management of POPF and reported time to POPF closure. Quality was assessed using the Cochrane Risk of Bias Tool and quality of pooled evidence was assessed using GRADE. Results: From 2,682 relevant citations, three studies including a total of 167 pateints were analyzed (85 patients in the enteral group and 82 patients in the parenteral group. The mean time to POPF closure was 3.46 days shorter in the enteral group (experimental) than the parenteral group (control), which failed to reach statistical significance (95% CI-1.39 to 8.31, P = 0.30, I2). The complication rates in both groups were low and there were no significant differences in complication rate (OR 1.69, 95% CI 0.52 to 5,47, P = 0.38) or length of stay (95% CI-9.21 to 10.74, P = 0.88). Conclusion: The rate of POPF closure is equivalent in patients receiving enteral feeds compared to those receiving parenteral feeds. The choice between enteral and parenteral feeds in the conservative management of POPF should be determined by individual patient factors.