Meta-analysis: Total Parenteral Nutrition Versus Total Enteral Nutrition in Predicted Severe Acute Pancreatitis

Background Total parenteral nutrition (TPN) as a traditional mode of treatment in severe acute pancreatitis was still used widely in clinical work. In addition, enteral nutrition treatment methods have developed; early enteral nutrition has already been highlighted for severe acute pancreatitis, but the therapeutic risks versus benefits need to be studied. Aims and Objective To compare total parenteral nutrition with total enteral nutrition (TEN) in patients with severe acute pancreatitis by performing a meta-analysis. Materials and Methods Electronic databases including PubMed, EMBASE, Science Citation Index, were searched to find relevant randomized controlled trials. Two reviewers independently identified relevant trials evaluating the effect of total parenteral nutrition and early enteral nutrion. Outcome measures were the mortality, hospital length of stay, infectious complications, duration of nutrition, organ failure and surgical intervention. Results Eight randomized controlled trials (RCTs) including 381 patients were identified. Meta-analysis demonstrated that TEN was significantly superior to TPN when considering mortality [p=0.001, 95% CI 0.37 (0.21-0.68)], infectious complications [p=0.004, 95% CI 0.46(0.27-0.78)], organ failure [p=0.02, 95% CI 0.44 (0.22-0.88)] and surgical intervention [p=0.003, 95% CI 0.41(0.23-0.74)]. While no difference between TEN and TPN when considering the hospital length of stay [p=0.22, 95% CI -14.10(-36.48-8.26)] and as for duration of nutrition [p=0.72, 95% CI -1.50(-9.56-6.56)] there was not enough data to compare the differences. Conclusion Total enteral nutritional support is associated with lower mortality, fewer infectious complications, decreased organ failure and surgical intervention rate compared to parenteral nutritional support.