A Meta-analysis of Efficacy of Enteral Nutrition and Total Parenteral Nutrition in Patients with Severe Acute Pancreatitis

Background: Nutrition support is an important treatment measure for severe acute pancreatitis (SAP),however, there are still debates on which should be used in SAP,enteral nutrition (EN) or total parenteral nutrition (TPN).Aims: To systematically evaluate the clinical efficacy of EN and TPN on patients with SAP/predicted SAP.Methods: Randomized controlled trials (RCT) comparing EN and TPN were searched in MEDLINE,EMBASE,Cochrane Library, Wanfang Data and China Journal Net from January 1966 to April 2010.Data concerning study design,patient characteristics and outcomes were extracted by two authors independently.Meta-analysis was conducted using RevMan 4.2 software.Results: Fourteen RCT involving 701 patients were included.Compared with TPN,EN was associated with significantly lower incidences of infection (RR=0.43,95% CI: 0.28-0.66,P0.0001),surgical intervention (RR = 0.45,95% CI: 0.29-0.70,P=0.0004),organ failure (RR=0.45,95% CI: 0.26-0.78,P=0.004) and mortality (RR=0.37, 95% CI: 0.23-0.58,P0.0001).Conclusions: EN is better than TPN in treating patients with SAP.EN should be used preferentially in the absence of contraindications.