The Safety Of Nasogastric Nutrition In Severe Acute Pancreatitis:A Systematic Review

Objective:To evaluate the safety and feasibility of nasogastric nutrition in early application of severe acute pancreatitis.Methods:All randomized controlled trials of nasogastric nutrition in patients with acute pancreatitis were searched from databases of Pubmed,EMbase,The Cochrane Library,WangFang Date,VIP,CNKI,inception to December 2017,and the relevant references of the included papers were also manually searched.The studies were selected according to the inclusion and exclusion criteria,evaluate the quality,and extract data.Then,Meta-analysis was performed using the RevMan5.3 software provided by the Cochrane collaboration.Among the retrieved studies,eight were found to be eligible for the qualitative review and seven for the meta-analysis.The outcome measures included tolerance rate,gastrointestinal adverse reactions,abdominal pain aggravation,stopping nasogastric proportion,energy balance,infection complications,MODS complications,mortality,average length of hospital.Results: Eight randomized controlled trials(RCTs)involving 417 patients with SAP were included.Evaluation of NG clinical application effect of nutrition;79% of SAP patients can tolerate nasogastric nutrition,and about21% of the patients had adverse reactions,but there were no adverse consequences.Meta analysis showed that there were no different in gastrointestinal adverse reactions [RR=1.12,95%CI(0.77,1.63),P=0.56],abdominal pain aggravation orrecurrence[RR=1.18,95%CI(0.67,2.10),P=0.56],and stopping nasogastric proportion [RR = 0.92,95% CI(0.73,2.78),energy balance [RR=0.98,95%CI(0.91,1.05),P=0.49],MODS complications [RR =0.92,95% CI(0.73,1.15),P = 0.46],Mortality[RR=0.85,95%CI(0.48,1.52),P=0.59],the average hospital time [RR = 0.92,95% CI(0.73,1.15),P= 0.46],However,the incidence of complications in nasogastric nutrition was lower than nasojejunal nutrition [RR=0.63,95%CI(0.44,0.89),P < 0.01].Conclusions:There were no difference of clinical efficacy in severe acute pancreatitis with nasogastric nutrition or nasojejunal nutrition.However,nasogastric is more convenient and may become an economic and safe way for acute pancreatitis enteral nutrition.