Efficacy Of Early Enteral Nutrition And Total Parenteral Nutrition In Patients With Severe Acute Pancreatitis: A Meta-analysis

Background: Severe acute pancreatitis (SAP) is a common clinical acuteabdomen，patients often have rapid onset and high fatality rate. Patients with SAP athigh catabolism state and the negative nitrogen balance, so energy consumption increasesignificantly. At the same time, SAP can also lead to serious metabolic disorder.Nutrition support is an important treatment measure for SAP. Total parenteral nutrition(TPN) is the traditional model of nutritional support. TPN can inhibit pancreaticsecretion, reduce gastrointestinal burden, but also to modify the intestinal barrierfunction and influence the health. Early enteral nutrition (EEN) is another way ofnutritional support. EEN can maintain the structure and function of intestinal mucosaand reducing occurrence of enterogenic infection, but the patients can easily causegastrointestinal discomfort. So there is still debate on which should be used in SAP,EEN or TPN.Objective：To evaluate the clinical efficacy and safety of EEN and TPN in patientswith SAP. Using meta-analysis to provides the basis of the evidence-based medicine forclinical practice.Methods: Randomized controlled trial (RCT) that compared EEN with TPN weresearched in MEDLINE, PubMed, China Biological Medicine Database(CBM), ChinaNational Knowledge Infrastructure Whole Article Database(CNKI), VIP ChineseJournals Database and Google Scholar, and the relevant references of the includedarticles were also manually searched. The retrieval time from january1966to january2013. The RCTs do not meet the inclusion criteria were ruled out by reading articlestitle, abstract or the full text. The outcome indexes were case fatality rate, pancreaticinfection incidence, incidence of multiple organ failure, surgical intervention incidence,diarrhea incidence and incidence of high blood sugar. Meta-analysis were performed with Revman5.2software after we assessed the article quality and extracted the data.Results：Nine RCTs involving453patients with SAP were included. EEN grouphas221patients, TPN group has232patients. All patients in EEN group implementedenteral nutrition through distal jejunum way, and the beginning of the treatment timewithin72hours. The result of meta-analysis showed that compared with TPN, EENcould significantly reduce case fatality rate〔RR=0.35、95%C（I0.20,0.61）、P=0.0002〕，pancreatitis-related infection〔RR=0.41、95%CI（0.24,0.71）、P=0.001〕，requiredrate of surgical intervention〔RR=0.50、95%CI（0.35,0.70）、P＜0.0001〕，incidenceof multiple organ failure〔RR=0.37、95%CI（0.18,0.77）、P=0.008〕，and incidenceof high blood sugar〔RR=0.47、95%CI（0.24,0.93）、P=0.03〕. But EEN had a higherincidence in diarrhea〔RR=5.54、95%CI（2.44,12.57）、P＜0.0001〕.Conclusion: Current study show that EEN can significantly reduce case fatalityrate and surgical intervention incidence of patients with SAP. At the same time, EENcan also reduce pancreatitis-related infection, multiple organ failure and high bloodsugar. EEN contributes to the prognosis of patients. Therefore, SAP patients withoutenteral nutrition contraindications should choose EEN as the first way of nutritionsupport.