Shahnaz Sultan, MD, MHSc; Chris E. Forsmark, MD
What is the relative effectiveness of enteral nutrition (EN) and total parenteral nutrition (TPN) in patients with acute pancreatitis?
Included studies compared EN (delivered through a nasoenteric feeding tube placed into the jejunum at or below the level of ligament of Treitz) with TPN (delivered through a central or peripheral venous line) in patients with acute pancreatitis diagnosed by clinical presentation and increased serum amylase. Studies also had to include a recognized assessment of severity of pancreatitis. Outcomes included mortality, multiple organ failure (MOF), systemic infection, operative intervention, local septic complications, other local complications, and length of hospital stay.
MEDLINE (to wk 3, Nov 2008), EMBASE/Excerpta Medica (to wk 49, 2008), Cochrane Library (4th quarter, 2008), SciSearch, ClinicalTrials.gov, bibliographies of identified trials and reviews, and personal files were searched for randomized controlled trials (RCTs) published in any language. 8 RCTs (n = 348, age range 21 to 91 y) met the inclusion criteria; all had complete follow-up, and 4 had adequate allocation concealment.
Meta-analysis showed that EN reduced mortality, MOF, systemic infections, and operative interventions compared with TPN (Table); EN and TPN did not differ for local septic complications, other local complications, or length of hospital stay (Table).
Enteral nutrition reduces mortality, multiple organ failure, systemic infections, and operative interventions more than total parenteral nutrition in patients with acute pancreatitis.
Enteral nutrition (EN) vs total parenteral nutrition (TPN) for acute pancreatitis*
*MOF = multiple organ failure; other abbreviations defined in Glossary. RRR, NNT, and CI calculated from data in article using a fixed-effect model. Length of follow-up in trials not reported.
Shahnaz Sultan, Chris E. Forsmark. Review: Enteral nutrition reduces mortality, multiple organ failure, and systemic infection more than TPN in acute pancreatitis. Ann Intern Med. 2010;153:JC1–6. doi: 10.7326/0003-4819-153-2-201007200-02006
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Published: Ann Intern Med. 2010;153(2):JC1-6.
Gastroenterology/Hepatology, Infectious Disease, Multi-Organ Failure and Sepsis, Pancreatic Disease, Pulmonary/Critical Care.
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