A Meta Analysis Of Early Enteral Nutrition Versus Total Parenteral Nutrition In Patients With Severe Acute Pancreatitis

Objective:To analyze the effect of early enteral nutrition( EN) and total parenteral nutrition ( TPN) in patients with severe acute pancreatitis. Methods:Randomized controlled trials of TPN and early EN in patients with severe acute pancreatitis were searched in Medline,Pubmed and Embase from Jan 1970 to June 2009,and Cochrane Library (Issue 2, 2009). Seven studies were enrolled into the analysis. The detail about the trial design ,characters of the subjects ,results of the studies were reviewed by two independent authors and analysed by using Revman 5.0.18 software. Results :Overall,we identified 332 publications,7 RCTS,in which 131 patients were randomly allocated to the EN group and 143 to the TPN group,met all inclusion criteria.Compared with TPN ,early EN was associated with a significantly lower incidence of pancreatic infections (OR=0.38,95 %CI :0.18～0.82 , P =0. 01 ),organ failure (OR=0.43,95 %CI :0.23～0.79 , P =0. 007) , fewer surgical interventions (OR=0.34,95 %CI :0. 18～0.63 , P =0. 0006) and mortaily( OR = 0. 41 , 95 % CI : 0. 19～0. 88 , P =0. 02). However , there was no significant difference in Total infections [0R=0.43,95%CI(0.17,1.10),P =0. 08]between patients with TPN and early EN. Conclusion:early EN could be the preferred nutrition feeding method in patients with severe acute pancreatitis.