Systematic Review And Meta-Analysis Of Early Oral Refeeding Versus Conventional Oral Refeeding For Acute Pancreatitis

Objective:To systematically review the efficacy and safety of early oral refeeding(EORF) and conventional oral refeeding(CORF) in acute pancreatitis.Methods:Pub Med, EMBASE, Cochrane central Register of Controlled trials(CENTRAL, the Cochrane Library), CBM, Wan Fang database, VIP and CNKI were searched from their inception to July, 2015 for randomized controlled trials(RCTs), comparing EORF and CORF in acute pancreatitis. The data were extracted and the methodology quality was assessed. Meta-analysis was performed using the Cochrane Collaboration’s Rev Man 5.3 software.Results:Five RCTs involving a total of 561 patients were included, 277 in the experimental group and 284 in the control group. Compared with CORF, EORF was associated with shorter length of hospital stays(LOHS) [SMD=-0.56, 95%CI=-0.90,-0.22, P=0.001]. There was no significant difference in the rate of abdominal pain relapse[RR=1.19, 95%CI=0.85, 1.67, P=0.30], abdominal distention[RR=1.35, 95%CI=0.87, 2.10, P=0.18], hyperglycemia[RR=1.40, 95%CI=0.48, 4.08, P=0.54], interrupted oral refeeding[RR=0.61, 95%CI=0.21, 1.78, P=0.62], high serum amylase [RR=0.83, 95%CI=0.41, 1.71, P=0.62]. But the rate of high serum lipase[RR=1.55,95%CI =1.02, 2.35, P=0.04] is higher in EORF group than in CORF group.Conclusion: Compared with CORF, EORF is associated with shorter length of hospital stays. There was no significant difference in the rate of abdominal complications. However, due to the limited quality of the included studies, more studies with large sample size are still needed to verity the above conclusion.