Enteral nutrition for severe acute pancreatitis within 48 hours after admission: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

PU Kunpeng ^1,2 , HUA Tianfeng ^1,2 , XIAO Wenyan ^1,2 , ZHANG Yang ^1,2 ,  YANG Min ^1,2

1. Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, P.R.China;
2. Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, 230601, P.R.China;

Corresponding author：

YANG Min, Email: 512130761@qq.com

Keywords：

Enteral nutrition; Parental nutrition; Severe acute pancreatitis; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.201811062

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Objectives To systematically review the efficacy and safety of enteral nutrition (EN) for severe acute pancreatitis (SAP) patients within 48 hours after admission.Methods PubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on early EN (starting within 48 hours after admission) in SAP from inception to October, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.Results A total of 9 RCTs involving 1 074 patients were included. The results of meta-analysis showed that: compared to patients with EN after 48 hours or parental nutrition, the patients given EN within 48 hours after admission had lower mortality (RR=0.53, 95%CI 0.29 to 0.96, P=0.036) and morbidity of multiple organ dysfunction syndrome (MODS) (RR=0.58, 95%CI 0.44 to 0.77, P<0.001). However, no significant differences were found in systemic inflammatory response syndrome (SIRS) (RR=1.00, 95%CI 0.86 to 1.16, P=1.00).Conclusions The current evidence shows that EN within 48 hours after admission can reduce the mortality and morbidity of MODS in SAP patients. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusions.

Citation： PU Kunpeng, HUA Tianfeng, XIAO Wenyan, ZHANG Yang, YANG Min. Enteral nutrition for severe acute pancreatitis within 48 hours after admission: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(6): 687-693. doi: 10.7507/1672-2531.201811062 Copy

1.	Warren M, McCarthy MS, Roberts PR. Practical application of the revised guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: a case study approach. Nutr Clin Pract, 2016, 31(3): 334-341.
2.	Yang R, Tenhunen J, Tonnessen TI. HMGB1 and histones play a significant role in inducing systemic inflammation and multiple organ dysfunctions in severe acute pancreatitis. Int J Inflam, 2017, 2017: 1817564.
3.	Li HC, Fan XJ, Chen YF, et al. Early prediction of intestinal mucosal barrier function impairment by elevated serum procalcitonin in rats with severe acute pancreatitis. Pancreatology, 2016, 16(2): 211-217.
4.	Schietroma M, Pessia B, Carlei F, et al. Intestinal permeability and systemic endotoxemia in patients with acute pancreatitis. Ann Ital Chir, 2016, 87: 138-144.
5.	Qiao SF, Lu TJ, Sun JB, et al. Alterations of intestinal immune function and regulatory effects of L-arginine in experimental severe acute pancreatitis rats. World J Gastroenterol, 2005, 11(39): 6216-6218.
6.	Schwarz M, Thomsen J, Meyer H, et al. Frequency and time course of pancreatic and extrapancreatic bacterial infection in experimental acute pancreatitis in rats. Surgery, 2000, 127(4): 427-432.
7.	Luo XJ, Peng Y. Enteral nutrition in severe acute pancreatitis. World Chinese J Digest, 2014, 22(12): 1658-1662.
8.	Ekelund M, Kristensson E, Ekelund M, et al. Total parenteral nutrition causes circumferential intestinal atrophy, remodeling of the intestinal wall, and redistribution of eosinophils in the rat gastrointestinal tract. Dig Dis Sci, 2007, 52(8): 1833-1839.
9.	Hua Z, Su Y, Huang X, et al. Analysis of risk factors related to gastrointestinal fistula in patients with severe acute pancreatitis: a retrospective study of 344 cases in a single Chinese center. BMC Gastroenterol, 2017, 17(1): 29.
10.	Corcoy R, Sanchez JM, Domingo P, et al. Nutrition in the patient with severe acute-pancreatitis. Nutrition, 1988, 4(4): 269-275.
11.	Feng P, He C, Liao G, et al. Early enteral nutrition versus delayed enteral nutrition in acute pancreatitis: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore), 2017, 96(46): e8648.
12.	Li JY, Yu T, Chen GC, et al. Enteral nutrition within 48 hours of admission improves clinical outcomes of acute pancreatitis by reducing complications: a meta-analysis. PLoS One, 2013, 8(6): e64926.
13.	Qi DS, Yu B, Huang J, et al. Meta-analysis of early enteral nutrition provided within 24 hours of admission on clinical outcomes in acute pancreatitis. J Parenter Enter Nutr, 2018, 42(7): 1139-1147.
14.	Reintam Blaser A, Starkopf J, Alhazzani W, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med, 2017, 43(3): 380-398.
15.	Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol, 2013, 108(9): 1400-1415.
16.	Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology, 2013, 13(4 Suppl 2): e1-e15.
17.	Sun JK, Mu XW, Li WQ, et al. Effects of early enteral nutrition on immune function of severe acute pancreatitis patients. World J Gastroenterol, 2013, 19(6): 917-922.
18.	Wang G, Wen J, Xu L, et al. Effect of enteral nutrition and ecoimmunonutrition on bacterial translocation and cytokine production in patients with severe acute pancreatitis. J Surg Res, 2013, 183(2): 592-597.
19.	Bakker OJ, van Brunschot S, van Santvoort HC, et al. Early versus on-demand nasoenteric tube feeding in acute pancreatitis. N Engl J Med, 2014, 371(21): 1983-1993.
20.	Eckerwall GE, Axelsson JB, Andersson RG. Early nasogastric feeding in predicted severe acute pancreatitis: A clinical, randomized study. Ann Surg, 2006, 244(6): 959-965.
21.	王艳, 李宝华, 李立, 等. 经鼻肠营养管超早期肠内营养支持治疗重症急性胰腺炎的临床对照研究. 中国微创外科杂志, 2014, 14(9): 786-791.
22.	Kalfarentzos F, Kehagias J, Mead N, et al. Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: Results of a randomized prospective trial. Br J Surg, 1997, 84(12): 1665-1669.
23.	Petrov MS, Kukosh MV, Emelyanov NV. A randomized controlled trial of enteral versus parenteral feeding in patients with predicted severe acute pancreatitis shows a significant reduction in mortality and in infected pancreatic complications with total enteral nutrition. Dig Surg, 2006, 23(5-6): 336-344.
24.	Wereszczynska-Siemiatkowska U, Swidnicka-Siergiejko A, Siemiatkowski A, et al. Early enteral nutrition is superior to delayed enteral nutrition for the prevention of infected necrosis and mortality in acute pancreatitis. Pancreas, 2013, 42(4): 640-646.
25.	Stimac D, Poropat G, Hauser G, et al. Early nasojejunal tube feeding versus nil-by-mouth in acute pancreatitis: A randomized clinical trial. Pancreatology, 2016, 16(4): 523-528.
26.	Al-Omran M, Albalawi ZH, Tashkandi MF, et al. Enteral versus parenteral nutrition for acute pancreatitis. Cochrane Database Syst Rev, 2010, (1): CD002837.
27.	Roberts KM, Nahikian-Nelms M, Ukleja A, et al. Nutritional aspects of acute pancreatitis. Gastroenterol Clin North Am, 2018, 47(1): 77-94.
28.	陈洁, 王兴鹏, 刘丕, 等. 持续性早期肠内营养对急性坏死型胰腺炎犬肠屏障功能的影响. 中华医学杂志, 2004, 84(20): 1726-1731.
29.	Foitzik T. Pancreatitis and nutrition. Significance of the gastrointestinal tract and nutrition for septic complications. Zentralbl Chir, 2001, 126(1): 4-9.

1. Warren M, McCarthy MS, Roberts PR. Practical application of the revised guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: a case study approach. Nutr Clin Pract, 2016, 31(3): 334-341.
2. Yang R, Tenhunen J, Tonnessen TI. HMGB1 and histones play a significant role in inducing systemic inflammation and multiple organ dysfunctions in severe acute pancreatitis. Int J Inflam, 2017, 2017: 1817564.
3. Li HC, Fan XJ, Chen YF, et al. Early prediction of intestinal mucosal barrier function impairment by elevated serum procalcitonin in rats with severe acute pancreatitis. Pancreatology, 2016, 16(2): 211-217.
4. Schietroma M, Pessia B, Carlei F, et al. Intestinal permeability and systemic endotoxemia in patients with acute pancreatitis. Ann Ital Chir, 2016, 87: 138-144.
5. Qiao SF, Lu TJ, Sun JB, et al. Alterations of intestinal immune function and regulatory effects of L-arginine in experimental severe acute pancreatitis rats. World J Gastroenterol, 2005, 11(39): 6216-6218.
6. Schwarz M, Thomsen J, Meyer H, et al. Frequency and time course of pancreatic and extrapancreatic bacterial infection in experimental acute pancreatitis in rats. Surgery, 2000, 127(4): 427-432.
7. Luo XJ, Peng Y. Enteral nutrition in severe acute pancreatitis. World Chinese J Digest, 2014, 22(12): 1658-1662.
8. Ekelund M, Kristensson E, Ekelund M, et al. Total parenteral nutrition causes circumferential intestinal atrophy, remodeling of the intestinal wall, and redistribution of eosinophils in the rat gastrointestinal tract. Dig Dis Sci, 2007, 52(8): 1833-1839.
9. Hua Z, Su Y, Huang X, et al. Analysis of risk factors related to gastrointestinal fistula in patients with severe acute pancreatitis: a retrospective study of 344 cases in a single Chinese center. BMC Gastroenterol, 2017, 17(1): 29.
10. Corcoy R, Sanchez JM, Domingo P, et al. Nutrition in the patient with severe acute-pancreatitis. Nutrition, 1988, 4(4): 269-275.
11. Feng P, He C, Liao G, et al. Early enteral nutrition versus delayed enteral nutrition in acute pancreatitis: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore), 2017, 96(46): e8648.
12. Li JY, Yu T, Chen GC, et al. Enteral nutrition within 48 hours of admission improves clinical outcomes of acute pancreatitis by reducing complications: a meta-analysis. PLoS One, 2013, 8(6): e64926.
13. Qi DS, Yu B, Huang J, et al. Meta-analysis of early enteral nutrition provided within 24 hours of admission on clinical outcomes in acute pancreatitis. J Parenter Enter Nutr, 2018, 42(7): 1139-1147.
14. Reintam Blaser A, Starkopf J, Alhazzani W, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med, 2017, 43(3): 380-398.
15. Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol, 2013, 108(9): 1400-1415.
16. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology, 2013, 13(4 Suppl 2): e1-e15.
17. Sun JK, Mu XW, Li WQ, et al. Effects of early enteral nutrition on immune function of severe acute pancreatitis patients. World J Gastroenterol, 2013, 19(6): 917-922.
18. Wang G, Wen J, Xu L, et al. Effect of enteral nutrition and ecoimmunonutrition on bacterial translocation and cytokine production in patients with severe acute pancreatitis. J Surg Res, 2013, 183(2): 592-597.
19. Bakker OJ, van Brunschot S, van Santvoort HC, et al. Early versus on-demand nasoenteric tube feeding in acute pancreatitis. N Engl J Med, 2014, 371(21): 1983-1993.
20. Eckerwall GE, Axelsson JB, Andersson RG. Early nasogastric feeding in predicted severe acute pancreatitis: A clinical, randomized study. Ann Surg, 2006, 244(6): 959-965.
21. 王艳, 李宝华, 李立, 等. 经鼻肠营养管超早期肠内营养支持治疗重症急性胰腺炎的临床对照研究. 中国微创外科杂志, 2014, 14(9): 786-791.
22. Kalfarentzos F, Kehagias J, Mead N, et al. Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: Results of a randomized prospective trial. Br J Surg, 1997, 84(12): 1665-1669.
23. Petrov MS, Kukosh MV, Emelyanov NV. A randomized controlled trial of enteral versus parenteral feeding in patients with predicted severe acute pancreatitis shows a significant reduction in mortality and in infected pancreatic complications with total enteral nutrition. Dig Surg, 2006, 23(5-6): 336-344.
24. Wereszczynska-Siemiatkowska U, Swidnicka-Siergiejko A, Siemiatkowski A, et al. Early enteral nutrition is superior to delayed enteral nutrition for the prevention of infected necrosis and mortality in acute pancreatitis. Pancreas, 2013, 42(4): 640-646.
25. Stimac D, Poropat G, Hauser G, et al. Early nasojejunal tube feeding versus nil-by-mouth in acute pancreatitis: A randomized clinical trial. Pancreatology, 2016, 16(4): 523-528.
26. Al-Omran M, Albalawi ZH, Tashkandi MF, et al. Enteral versus parenteral nutrition for acute pancreatitis. Cochrane Database Syst Rev, 2010, (1): CD002837.
27. Roberts KM, Nahikian-Nelms M, Ukleja A, et al. Nutritional aspects of acute pancreatitis. Gastroenterol Clin North Am, 2018, 47(1): 77-94.
28. 陈洁, 王兴鹏, 刘丕, 等. 持续性早期肠内营养对急性坏死型胰腺炎犬肠屏障功能的影响. 中华医学杂志, 2004, 84(20): 1726-1731.
29. Foitzik T. Pancreatitis and nutrition. Significance of the gastrointestinal tract and nutrition for septic complications. Zentralbl Chir, 2001, 126(1): 4-9.

Chinese Journal of Evidence-Based Medicine

Enteral nutrition for severe acute pancreatitis within 48 hours after admission: a meta-analysis

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