Enteral nutrition and the risk of mortality and infectious complications in patients with severe acute pancreatitis: a meta-analysis of randomized trials.
OBJECTIVE
To compare the effect of enteral vs parenteral nutrition in patients with severe acute pancreatitis for clinically relevant outcomes.


METHODS
A computerized literature search was performed in the MEDLINE, EMBASE, and Cochrane databases for articles published from January 1, 1966, until December 15, 2006.


METHODS
From 253 publications screened, 5 randomized controlled trials comparing enteral and parenteral nutrition in patients with predicted severe acute pancreatitis met the inclusion criteria.


METHODS
Information on study design, patient characteristics, and acute pancreatitis outcomes were independently extracted by two of us using a standardized protocol.


RESULTS
A meta-analysis of randomized controlled trials was performed using a random-effects model. Enteral feeding reduced the risk of infectious complications (relative risk, 0.47; 95% confidence interval, 0.28-0.77; P < .001), pancreatic infections (0.48; 0.26-0.91; P = .02), and mortality (0.32; 0.11-0.98; P = .03). The risk reduction for organ failure was not statistically significant (0.67; 0.30-1.52; P = .34).


CONCLUSIONS
Enteral nutrition results in clinically relevant and statistically significant risk reduction for infectious complications, pancreatic infections, and mortality in patients with predicted severe acute pancreatitis.
Petrov
Maxim S
MS
University Medical Center Utrecht, PO Box 85500, HP G04.228, 3508 GA Utrecht, The Netherlands.
van Santvoort
Hjalmar C
HC
Besselink
Marc G H
MG
van der Heijden
Geert J M G
GJ
Windsor
John A
JA
Gooszen
Hein G
HG
D004750:Enteral Nutrition; D006801:Humans; D010195:Pancreatitis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D010288:Parenteral Nutrition; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome