Early Enteral Nutrition versus Total Parenteral Nutrition after Pancreaticoduodenectomy: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

GAO Fengwei ¹ , LEI Zehua ¹ ,  HU Weiming ² , YU Shenlin ¹ , WANG Zhigang ¹ , WANG Zhixu ¹ , JIANG Hongyuan ¹

1. Department of Gastrointestinal Hepatobiliary Surgery,The People’s Hospital of Leshan, Leshan 614000, China; 2. West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

HU Weiming, Email: gao-_-chao@163.com

Keywords：

Pancreaticoduodenectomy; Total parenteral nutrition; Enteral nutrition; Systematic review; Meta-analysis; Randomized controlled trials

DOI：

10.7507/1672-2531.20110197

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Objective 　To evaluate the effectiveness and safety of early enteral nutrition (EN) versus total parenteral nutrition (TPN) after pancreaticoduodenectomy (PD).
Methods 　Such databases as MEDLINE, EMbase, The Cochrane Library, CBM, VIP, CNKI were electronically searched to collect the randomized controlled trials (RCTs) about EN versus TPN after PD published from 2000 to March 2010. The quality of the included trials was assessed according to the inclusive and exclusive criteria, and the data were extracted and analyzed by using RevMan 5.0 software.
Results 　A total of 4 RCTs involving 322 PD patients were included. The meta-analysis showed that the EN (the treatment group) was superior to the TPN (the control group) in the average postoperative hospital stay (MD= –2.34, 95%CI –3.91 to –0.77, P lt;0.05), the total incidence rate of complication (RR=0.75, 95%CI 0.57 to 0.99, P=0.04), the recovery time of enterocinesia (MD= –29.87, 95%CI –33.01 to –26.73, P lt;0.05) and the nutrition costs (MD= –30.51, 95%CI –35.78 to –25.24, P lt;0.05); there were no differences in mortality (RR=0.23, 95%CI 0.03 to 2.03, P=0.19), pancreatic leakage (RR=0.78, 95%CI 0.45 to 1.35, P=0.38), infectious complications (RR=0.71, 95%CI 0.43 to 1.18, P=0.19), non-infectious complications (RR=0.78, 95%CI 0.5 1 to 1.20, P=0.26) and postoperative serum albumin level (MD= –0.79, 95%CI –2.84 to 1.27, P=0.45).
Conclusion 　Compared with total parenteral nutrition, the enteral nutrition used earlier after pancreatoduodenectomy shows significant advantages. But more reasonably-designed and double blind RCTs with large scale are expected to provide high quality proof.

Citation： GAO Fengwei,LEI Zehua,HU Weiming,YU Shenlin,WANG Zhigang,WANG Zhixu,JIANG Hongyuan. Early Enteral Nutrition versus Total Parenteral Nutrition after Pancreaticoduodenectomy: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2011, 11(10): 1166-1171. doi: 10.7507/1672-2531.20110197 Copy

1.	2 Howard L, Ashely C. Nutrition in the perioperative patient. Annual Review of Nutrition , 2003, 23(876): 263-282.
2.	严律南. 梗阻性黄疸. 见: 黄洁夫, 主编. 腹部外科学. 第1版. 北京: 人民卫生出版社, 2001: 1512 -1516.
3.	蒋朱明, 临床肠内营养支持的新进展. 蒋朱明, 吴蔚然, 主编. 肠内营养. 北京: 人民卫生出版社, 2004: p293 .
4.	李元新, 黎介寿. 肠内营养支持的进展. 江苏临床医学杂志. 2002, 36(6): 90-95.
5.	Finck C. Enteral versus parenteral nutrition in the critically ill. Nutrition , 2000, 16(5): 393-394.
6.	Martignoni ME, Friess H, Sell F, et al . Enteral Nutrition Prolongs Delayed Gastric Emptying in patients after Whipple Resection. Am J. Surg , 2000, 180(1): 18-23.
7.	Gri?as S, Gulbinas A, Barauskas G, et al . A comparison of the effectiveness of the early enteral and natural nutrition after pancreatoduodenectomy. Medicina (Kaunas) , 2008, 44(9): 678-686.
8.	张崇广, 吴恩. 肠内营养支持的新进展. 中国现代医学杂志, 2003, 13(12): 46-47.
9.	王丽波, 杨玉美. 早期肠内营养对胰十二指肠切除术后患者营养状况的影响. 南方医科大学学报, 2009, 29(3): 431-432.
10.	Bodoky G, Harsanyi L, Tihanyi T, et al . Effect of enteral nutrition on exocrine pancreatic function. The American Journal of Surgery , 1991, 161(1): 144-148.
11.	Brennan MF, Pisters PW, Posner M, et al . A Prospective Randomized Trial of Total Parenteral Nutrition After Major Pancreatic Resection for Malignancy. Ann Surg , 1994, 220(4): 436-444.
12.	Gianotti L, Braga M, Gentilini O, et al . Artificial nutrition after pancreaticoduodenectomy. Pancreas , 2000, 21(4): 344-351.
13.	Baradi H, Walsh RM, Henderson JM, et al . Postoperative jejunal feeding and outcome of pancreaticoduodenectomy. Journal of Gastrointestinal Surgery , 2004, 8(4): 428-433.
14.	Heslin MJ, Latkany L, Leung D, et al . A Prospective, randomized trial of early enteral feeding after resection of upper gastrointestinal malignancy. Ann Surg , 1997, 226(4): 567-580.
15.	余开焕, 陈祖兵, 陈辰. 胰十二指肠切除术后的营养支持. 临床外科杂志, 2007, 15(12): 833-835.
16.	何显力, 马庆久, 鲁建国, 等. 胰十二指肠切除术后肠内和肠外营养支持的对比研究. 中国现代医学杂志, 2004, 14(17): 85-88.
17.	许媛, 何伟, 葛庆岗, 等. 外科重症病人肠内营养相关并发症分析. 肠外与肠内营养, 2001, 8(3): 151-154.
18.	温冰, 娄礼广. 围手术期营养支持在胰十二指肠切除术病人的临床应用. 肠外与肠内营养, 2007, 14(4): 219-222.
19.	李为苏, 李宁. 营养支持的并发症及其防治. 中国实用外科杂志, 2001, 21(11): 697-701.

1. 2 Howard L, Ashely C. Nutrition in the perioperative patient. Annual Review of Nutrition , 2003, 23(876): 263-282.
2. 严律南. 梗阻性黄疸. 见: 黄洁夫, 主编. 腹部外科学. 第1版. 北京: 人民卫生出版社, 2001: 1512 -1516.
3. 蒋朱明, 临床肠内营养支持的新进展. 蒋朱明, 吴蔚然, 主编. 肠内营养. 北京: 人民卫生出版社, 2004: p293 .
4. 李元新, 黎介寿. 肠内营养支持的进展. 江苏临床医学杂志. 2002, 36(6): 90-95.
5. Finck C. Enteral versus parenteral nutrition in the critically ill. Nutrition , 2000, 16(5): 393-394.
6. Martignoni ME, Friess H, Sell F, et al . Enteral Nutrition Prolongs Delayed Gastric Emptying in patients after Whipple Resection. Am J. Surg , 2000, 180(1): 18-23.
7. Gri?as S, Gulbinas A, Barauskas G, et al . A comparison of the effectiveness of the early enteral and natural nutrition after pancreatoduodenectomy. Medicina (Kaunas) , 2008, 44(9): 678-686.
8. 张崇广, 吴恩. 肠内营养支持的新进展. 中国现代医学杂志, 2003, 13(12): 46-47.
9. 王丽波, 杨玉美. 早期肠内营养对胰十二指肠切除术后患者营养状况的影响. 南方医科大学学报, 2009, 29(3): 431-432.
10. Bodoky G, Harsanyi L, Tihanyi T, et al . Effect of enteral nutrition on exocrine pancreatic function. The American Journal of Surgery , 1991, 161(1): 144-148.
11. Brennan MF, Pisters PW, Posner M, et al . A Prospective Randomized Trial of Total Parenteral Nutrition After Major Pancreatic Resection for Malignancy. Ann Surg , 1994, 220(4): 436-444.
12. Gianotti L, Braga M, Gentilini O, et al . Artificial nutrition after pancreaticoduodenectomy. Pancreas , 2000, 21(4): 344-351.
13. Baradi H, Walsh RM, Henderson JM, et al . Postoperative jejunal feeding and outcome of pancreaticoduodenectomy. Journal of Gastrointestinal Surgery , 2004, 8(4): 428-433.
14. Heslin MJ, Latkany L, Leung D, et al . A Prospective, randomized trial of early enteral feeding after resection of upper gastrointestinal malignancy. Ann Surg , 1997, 226(4): 567-580.
15. 余开焕, 陈祖兵, 陈辰. 胰十二指肠切除术后的营养支持. 临床外科杂志, 2007, 15(12): 833-835.
16. 何显力, 马庆久, 鲁建国, 等. 胰十二指肠切除术后肠内和肠外营养支持的对比研究. 中国现代医学杂志, 2004, 14(17): 85-88.
17. 许媛, 何伟, 葛庆岗, 等. 外科重症病人肠内营养相关并发症分析. 肠外与肠内营养, 2001, 8(3): 151-154.
18. 温冰, 娄礼广. 围手术期营养支持在胰十二指肠切除术病人的临床应用. 肠外与肠内营养, 2007, 14(4): 219-222.
19. 李为苏, 李宁. 营养支持的并发症及其防治. 中国实用外科杂志, 2001, 21(11): 697-701.

Chinese Journal of Evidence-Based Medicine

Early Enteral Nutrition versus Total Parenteral Nutrition after Pancreaticoduodenectomy: A Systematic Review

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