title: Meta-analysis: total parenteral nutrition versus total enteral nutrition in predicted severe acute pancreatitis.
abstract: BACKGROUND
  Total parenteral nutrition (TPN) as a traditional mode of treatment in severe acute pancreatitis was still used widely in clinical work. In addition, enteral nutrition treatment methods have developed; early enteral nutrition has already been highlighted for severe acute pancreatitis, but the therapeutic risks versus benefits need to be studied.
  
  
  OBJECTIVE
  To compare total parenteral nutrition with total enteral nutrition (TEN) in patients with severe acute pancreatitis by performing a meta-analysis.
  
  
  METHODS
  Electronic databases including PubMed, EMBASE, Science Citation Index, were searched to find relevant randomized controlled trials. Two reviewers independently identified relevant trials evaluating the effect of total parenteral nutrition and early enteral nutrion. Outcome measures were the mortality, hospital length of stay, infectious complications, duration of nutrition, organ failure and surgical intervention.
  
  
  RESULTS
  Eight randomized controlled trials (RCTs) including 381 patients were identified. Meta-analysis demonstrated that TEN was significantly superior to TPN when considering mortality [p=0.001, 95%CI 0.37(0.21-0.68)], infectious complications [p=0.004, 95%CI 0.46(0.27-0.78)], organ failure [p=0.02, 95%CI 0.44(0.22-0.88)] and surgical intervention [p=0.003, 95%CI 0.41(0.23-0.74)].While no difference between TEN and TPN when considering the hospital length of stay [p=0.22, 95%CI -14.10(-36.48-8.26)] and as for duration of nutrition [p=0.72, 95%CI -1.50(-9.56-6.56)] there was not enough data to compare the differences.
  
  
  CONCLUSIONS
  Total enteral nutritional support is associated with lower mortality, fewer infectious complications, decreased organ failure and surgical intervention rate compared to parenteral nutritional support.
authors.affiliation: Department of Gastroenterology, Zhongnan Hospital of Wuhan University School of Medicine, China.
authors.forename: Fengming
authors.initials: F
authors.lastname: Yi
authors.forename: Liuqing
authors.initials: L
authors.lastname: Ge
authors.forename: Jie
authors.initials: J
authors.lastname: Zhao
authors.forename: Yuan
authors.initials: Y
authors.lastname: Lei
authors.forename: Feng
authors.initials: F
authors.lastname: Zhou
authors.forename: Zhifen
authors.initials: Z
authors.lastname: Chen
authors.forename: Youqing
authors.initials: Y
authors.lastname: Zhu
authors.forename: Bing
authors.initials: B
authors.lastname: Xia
mesh_terms: D000208:Acute Disease; D004750:Enteral Nutrition; D017052:Hospital Mortality; D006801:Humans; D007239:Infections / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D015337:Multicenter Studies as Topic; D009102:Multiple Organ Failure / Q000453:epidemiology; D010195:Pancreatitis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology