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Evidence summaries

Enteral Versus Total Parenteral Nutrition for Acute Pancreatitis

In patients with acute pancreatitis, enteral nutrition appears to reduce mortality, multiple organ failure, systemic infections, and the need for operative interventions compared to total parenteral nutrition. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 8 studies with a total of 348 subjects. Comparing enteral nutrition (EN) to total parenteral nutrition (TPN) for acute pancreatitis, the RR for death was 0.50 (95% CI 0.28 to 0.91), for multiple organ failure (MOF) 0.55 (95% CI 0.37 to 0.81), for systemic infection 0.39 (95% CI 0.23 to 0.65), for operative interventions 0.44 (95% CI 0.29 to 0.67), for local septic complications 0.74 (95% CI 0.40 to 1.35), and for other local complications 0.70 (95% CI 0.43 to 1.13). Mean length of hospital stay was reduced by 2.37 days in EN vs TPN groups (95% CI -7.18 to 2.44). Furthermore, a subgroup analysis for EN vs TPN in patients with severe acute pancreatitis showed a RR for death of 0.18 (95% CI 0.06 to 0.58) and a RR for MOF of 0.46 (95% CI 0.16 to 1.29).

Comment: The quality of evidence is downgraded by imprecise results (few outcome events).

    References

    • Al-Omran M, Albalawi ZH, Tashkandi MF, Al-Ansary LA. Enteral versus parenteral nutrition for acute pancreatitis. Cochrane Database Syst Rev 2010;(1):CD002837. [PubMed].

Primary/Secondary Keywords