[Critical appraisal: enteral nutrition is better than parenteral nutrition for patients with acute pancreatitis].
OBJECTIVE
To compare the safety and clinical outcomes of enteral and parenteral nutrition in patients with acute pancreatitis.


METHODS
Medline, Embase, Cochrane controlled trials register, and citation review of relevant primary and review articles.


METHODS
Randomized controlled studies that compared enteral nutrition with parenteral nutrition in patients with acute pancreatitis. From 117 articles screened, six were identified as randomized controlled trials and were included for data extraction.


METHODS
Six studies with 263 participants were analyzed. Descriptive and outcome data were extracted. Main outcome measures were infections, complications other than infections, operative interventions, length of hospital stay, and mortality. The metaanalysis was performed with the random effects model.


RESULTS
Enteral nutrition was associated with a significantly lower incidence of infections (relative risk 0.45; 95% confidence interval 0.26 to 0.78, P= 0.004), reduced surgical interventions to control pancreatitis (0.48, 0.22 to 1.0, P= 0.05), and a reduced length of hospital stay (mean reduction 2.9 days, 1.6 days to 4.3 days, P <0.001). There were no significant differences in mortality (relative risk 0.66, 0.32 to 1.37, P = 0.3) or non-infectious complications (0.61, 0.31 to 1.22, P= 0.16) between the two groups of patients.


CONCLUSIONS
Enteral nutrition should be the preferred route of nutritional support in patients with acute pancreatitis.
Manríquez
Juan Jorge
JJ
Unidad de Medicina Basada en Evidencia, Chile.
Letelier
Luz María
LM