Clinical Question: Should parenteral nutrition be used preferentially over enteral nutrition in patients with acute pancreatitis?

Setting: Various (meta-analysis)

Study Design: Meta-analysis (randomized controlled trials)

Synopsis: Investigators in this meta-analysis combined the results of six studies that compared enteral and parenteral nutrition with regard to effectiveness and safety among 263 patients. The authors conducted an appropriate search for research trials, with two authors independently searching four databases. They examined bibliographies of identified articles and queried experts. Results from the studies were extracted independently by two authors from the trials. Four of the six studies were of low quality (i.e., Jadad score of less than 3).

Enteral nutrition via nasojejunal tube produced superior results with significantly fewer infections (relative risk [RR] = 0.45; number needed to treat = seven; 95 percent confidence interval [CI], 5 to 16). Complications other than infections did not differ between the two modes of nutrition. The need for surgical interventions, evaluated in four studies, was significantly less in patients who were fed enterally (RR = 0.48; 95 percent CI, 0.23 to 0.99). Overall, length of hospital stay was shorter in the enteral nutrition group, although significant heterogeneity existed among the studies. Mortality was similar in the two groups. Enteral nutrition prevented atrophy of gut lymphoid tissue, bacterial overgrowth in the intestine, and increased intestinal permeability, while the jejunal delivery resulted in little increase in enzyme output from the pancreas.

Bottom Line: Nasojejunal enteral nutrition in patients with acute pancreatitis results in fewer infections and surgical interventions, and possibly shorter hospital stays than parenteral nutrition. (Level of Evidence: 1b–)