Systematic review: nutritional support in acute pancreatitis.
BACKGROUND
There has been controversy concerning the merits of enteral and parenteral nutrition compared with no supplementary nutrition in the management of patients with acute pancreatitis.


OBJECTIVE
To perform a systematic review of the data from randomized controlled trials (RCTs) in acute pancreatitis that compares enteral nutrition with no supplementary nutrition, parenteral nutrition with no supplementary nutrition and enteral nutrition with parenteral nutrition.


METHODS
A search was undertaken in the MEDLINIE, EMBASE and the Cochrane Central Register of Controlled Trials.


RESULTS
Fifteen RCTs were included. Enteral nutrition, when compared with no supplementary nutrition, was associated with no significant change in infectious complications: ratio of relative risks (RR) 0.56, 95% confidence interval (CI) 0.07-4.32, P = 0.58, but a significant reduction in mortality: ratio of RR 0.22, 95% CI 0.07-0.70, P = 0.01. Parenteral nutrition, when compared with no supplementary nutrition, was associated with no significant change in infectious complications: RR 1.36, 95% CI 0.18-10.40; P = 0.77, but a significant reduction in mortality: RR 0.36, 95% CI 0.13-0.97, P = 0.04. Enteral nutrition, when compared with parenteral nutrition, was associated with a significant reduction in infectious complications: RR 0.41, 95% CI 0.30-0.57, P < 0.001, but no significant change in mortality: RR 0.60, 95% CI 0.32-1.14, P = 0.12.


CONCLUSIONS
The use of either enteral or parenteral nutrition, in comparison with no supplementary nutrition, is associated with a lower risk of death in acute pancreatitis. Enteral nutrition is associated with a lower risk of infectious complications compared with parenteral nutrition.
Petrov
M S
MS
Department of Surgery, Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russia. max.petrov@gmail.com
Pylypchuk
R D
RD
Emelyanov
N V
NV
D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology; D016206:Databases, Bibliographic; 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