Enteral nutrition and the risk of mortality and infectious complications in patients with severe acute pancreatitis: a meta-analysis of randomized trials

Maxim S Petrov, Hjalmar C van Santvoort, Marc G H Besselink, Geert J M G van der Heijden, John A Windsor, Hein G Gooszen
Archives of Surgery 2008, 143 (11): 1111-7

OBJECTIVE: To compare the effect of enteral vs parenteral nutrition in patients with severe acute pancreatitis for clinically relevant outcomes.

DATA SOURCES: A computerized literature search was performed in the MEDLINE, EMBASE, and Cochrane databases for articles published from January 1, 1966, until December 15, 2006.

STUDY SELECTION: From 253 publications screened, 5 randomized controlled trials comparing enteral and parenteral nutrition in patients with predicted severe acute pancreatitis met the inclusion criteria.

DATA EXTRACTION: Information on study design, patient characteristics, and acute pancreatitis outcomes were independently extracted by two of us using a standardized protocol.

DATA SYNTHESIS: A meta-analysis of randomized controlled trials was performed using a random-effects model. Enteral feeding reduced the risk of infectious complications (relative risk, 0.47; 95% confidence interval, 0.28-0.77; P < .001), pancreatic infections (0.48; 0.26-0.91; P = .02), and mortality (0.32; 0.11-0.98; P = .03). The risk reduction for organ failure was not statistically significant (0.67; 0.30-1.52; P = .34).

CONCLUSIONS: Enteral nutrition results in clinically relevant and statistically significant risk reduction for infectious complications, pancreatic infections, and mortality in patients with predicted severe acute pancreatitis.

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