Meta-Analysis of Early Enteral Nutrition Provided Within 24 Hours of Admission on Clinical Outcomes in Acute Pancreatitis

Abstract

Background: Enteral nutrition (EN) is more beneficial than parenteral nutrition (PN) in reducing organ failure, infectious complications, and mortality of acute pancreatitis (AP), but its timing is controversial. We attempted to evaluate the safety and clinical outcomes of early EN within 24 hours of admission in patients with AP, especially in predicted severe or severe acute pancreatitis (SAP).

Methods: We searched PubMed, EMBASE Databases, Web of Science, and the Cochrane Library for relevant articles before June 2016 using RevMan 5.2 software.

Results: Eight studies containing 727 patients with AP were analyzed in the meta-analysis. Comparing early EN to late EN or total parental nutrition in AP, the odds ratios (OR) were 0.56 (95% CI 0.23 -1.34) for the risk of mortality, 0.40 (95% CI 0.20-0.79) for multiple organ failure, 0.57 (95% CI 0.23-1.42) for infectious complications, 0.45 (95% CI 0.17-1.21) for adverse events, and 0.83 (95% CI 0.59-1.18) for pancreatic-related infections. Furthermore, subgroup analysis for early EN in predicted severe or SAP showed a significant reduction in multiple organ failure (OR 0.30; 95% CI 0.09-0.96) and pancreatic-related infections (OR 0.51, 95% CI 0.29-0.88). Early EN provided no benefits for mild to moderate AP.

Conclusion: Early EN within 24 hours of admission is safe and provides benefits for predicted severe or SAP, but not for mild to moderate pancreatitis.

Keywords: acute pancreatitis; early enteral nutrition; meta-analysis; timing.