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Enteral Nutrition Appears Superior to Parenteral Nutrition for Patients With Acute Pancreatitis

Enteral nutrition appears to be more effective than parenteral nutrition for patients with acute pancreatitis, according to the findings of a meta-analysis.

Paul E. Marik, Professor, Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pennsylvania, and Gary P. Zaloga, Medical Director, Methodist Research Institute, Indianapolis, Indiana, both in the United States, conduced a meta-analysis of randomised controlled trials that compared the safety and clinical outcomes of patients with acute pancreatitis who received either enteral or parenteral nutrition.

They identified 6 studies, including a total of 263 participants admitted to hospital with acute pancreatitis. The studies compared enteral versus parenteral nutrition with primary outcome variables including number of infections, total number of non-infectious complications, number of surgical interventions, length of hospital stay, and hospital mortality.

Data on the incidence of infection from the 6 studies showed that among patients who received enteral nutrition had a significantly lower risk of infections, such as pneumonia, abdominal abscess, pancreatic abscess, wound infections, and blood stream infection, compared to those who received parenteral nutrition (relative risk [RR] = .45).

The 5 studies that reported complications other than infections, including adult respiratory distress syndrome, multi-organ failure, acute pseudocysts, and pancreatic fistula, showed no significant difference in the relative risk between enteral and parenteral nutrition (RR -= .61).

Patients who received enteral nutrition had a relative risk of 0.48 for surgical interventions compared with those receiving parenteral nutrition, according to data from 4 studies. Also, data from all 6 studies showed that patients given enteral nutrition had a mean 2.9 days shorter length of hospital stay than patients receiving parenteral nutrition.

There was no significant difference in hospital mortality between groups (RR = .66), according to data from all the studies.

"Although the available data are limited," the authors conclude, "the best available evidence does not support the use of total parenteral nutrition in patients with acute pancreatitis."
BMJ, doi:10.1136/bmj.38118.593900.55 (published 2 June 2004)

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