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Comparison of complications attributable to enteral and parenteral nutrition in predicted severe acute pancreatitis: a systematic review and meta-analysis

  • Maxim S. Petrov (a1) and Kevin Whelan (a2)
Abstract

Enteral nutrition (EN) reduces infectious complications and mortality compared with parenteral nutrition (PN) in patients with predicted severe acute pancreatitis. However, to date the complications attributable to the administration of EN and PN in this patient group have not been comprehensively studied. The aim of the study was to systematically review the complications related to the use of nutrition in patients with predicted severe acute pancreatitis receiving EN v. PN. The Cochrane Library, MEDLINE and Scopus were searched. Randomised controlled trials (RCT) of EN v. PN in predicted severe acute pancreatitis were selected. Pooled estimates of complications were expressed as OR with corresponding 95 % CI. Data from five RCT were meta-analysed. Diarrhoea occurred in six of ninety-two (7 %) patients receiving PN and twenty-four of eighty-two (29 %) patients receiving EN (OR 0·20; 95 % CI 0·09, 0·43; P < 0·001). Hyperglycaemia developed in twenty-one of ninety-two (23 %) patients receiving PN and nine of eighty-two (11 %) receiving EN (OR 2·59; 95 % CI 1·13, 5·94; P = 0·03). Given a significant reduction in infectious complications and mortality associated with the use of EN over PN that has been consistently demonstrated in previous studies, the former should be the treatment of choice in acute pancreatitis. Further clinical studies should investigate the strategies to mitigate the complications of enteral tube feeding in patients with acute pancreatitis.

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Corresponding author
*Corresponding author: Dr Maxim S. Petrov, fax +64 9 377 9656, email max.petrov@gmail.com
References
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1 Curtis, CS & Kudsk, KA (2007) Nutrition support in pancreatitis. Surg Clin North Am 87, 14031415.
2 Wan, X, Gong, Z, Wu, K, et al. (2003) Gastrointestinal dysmotility in patients with acute pancreatitis. J Gastroenterol Hepatol 18, 5762.
3 Smout, AJ (2004) Small intestinal motility. Curr Opin Gastroenterol 20, 7781.
4 Petrov, MS (2009) Correlation between obesity and hyperglycemia in acute pancreatitis with systemic complications: the third-variable problem. Pancreas 38, 101.
5 Liamis, G, Gianoutsos, C & Elisaf, M (2001) Acute pancreatitis-induced hypomagnesemia. Pancreatology 1, 7476.
6 Petrov, MS, van Santvoort, HC, Besselink, MG, et al. (2008) Enteral nutrition and the risk of mortality and infectious complications in patients with severe acute pancreatitis: a meta-analysis of randomized trials. Arch Surg 143, 11111117.
7 Marik, PE (2009) What is the best way to feed patients with pancreatitis? Curr Opin Crit Care 15, 131138.
8 Petrov, MS (2007) Enteral nutrition: goody or good-for-nothing in acute pancreatitis? Am J Gastroenterol 102, 18281829.
9 Al-Omran, M, Albalawi, ZH & Tashkandi, MF, et al. (2010) Enteral versus parenteral nutrition for acute pancreatitis. The Cochrane Database of Systematic Reviews 2010, issue 1, CD002837. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002837/frame.html.
10 Forsmark, CE & Baillie, J (2007) AGA Institute technical review on acute pancreatitis. Gastroenterology 132, 20222044.
11 Meier, R, Ockenga, J, Pertkiewicz, M, et al. (2006) ESPEN Guidelines on Enteral Nutrition: pancreas. Clin Nutr 25, 275284.
12 American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors (2009) Clinical guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients, 2009. JPEN J Parenter Enteral Nutr 33, 255259.
13 Braunschweig, CL, Levy, P, Sheean, PM, et al. (2001) Enteral compared with parenteral nutrition: a meta-analysis. Am J Clin Nutr 74, 534542.
14 Peter, JV, Moran, JL & Phillips-Hughes, J (2005) A meta-analysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients. Crit Care Med 33, 213220.
15 Gramlich, L, Kichian, K, Pinilla, J, et al. (2004) Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition 20, 843848.
16 Petrov, MS, Correia, MI & Windsor, JA (2008) Nasogastric tube feeding in predicted severe acute pancreatitis. A systematic review of the literature to determine safety and tolerance. JOP 9, 440448.
17 Leandro, G (2005) Meta-Analysis in Medical Research, pp. 98. Oxford: Blackwell Publishing, BMJ Books.
18 McClave, SA, Greene, LM, Snider, HL, et al. (1997) Comparison of the safety of early enteral vs parenteral nutrition in mild acute pancreatitis. JPEN J Parenter Enteral Nutr 21, 1420.
19 Windsor, AC, Kanwar, S, Li, AG, et al. (1998) Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut 42, 431435.
20 Abou-Assi, S, Craig, K & O'Keefe, SJ (2002) Hypocaloric jejunal feeding is better than total parenteral nutrition in acute pancreatitis: results of a randomized comparative study. Am J Gastroenterol 97, 22552262.
21 Paraskeva, C, Smailis, D, Priovolos, A, et al. (2001) Early enteral nutrition reduces the need for surgery in severe acute pancreatitis. Pancreatology 1, 372.
22 Olah, A, Pardavi, G, Belagyi, T, et al. (2002) Early nasojejunal feeding in acute pancreatitis is associated with a lower complication rate. Nutrition 18, 259262.
23 Doley, RP, Yadav, TD, Wig, JD, et al. (2009) Enteral nutrition in severe acute pancreatitis. JOP 10, 157162.
24 Wu, XM, Ji, KQ, Wang, HY, et al. (2010) Total enteral nutrition in prevention of pancreatic necrotic infection in severe acute pancreatitis. Pancreas 39, 248251.
25 Eckerwall, GE, Axelsson, JB & Andersson, RG (2006) Early nasogastric feeding in predicted severe acute pancreatitis: a clinical, randomized study. Ann Surg 244, 959965.
26 Kalfarentzos, F, Kehagias, J, Mead, N, et al. (1997) Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial. Br J Surg 84, 16651669.
27 Gupta, R, Patel, K, Calder, PC, et al. (2003) A randomised clinical trial to assess the effect of total enteral and total parenteral nutritional support on metabolic, inflammatory and oxidative markers in patients with predicted severe acute pancreatitis (APACHE II>or = 6). Pancreatology 3, 406413.
28 Louie, BE, Noseworthy, T, Hailey, D, et al. (2005) 2004 MacLean-Mueller prize: enteral or parenteral nutrition for severe pancreatitis: a randomized controlled trial and health technology assessment. Can J Surg 48, 298306.
29 Petrov, MS, Kukosh, MV & Emelyanov, NV (2006) 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 23, 336344.
30 Casas, M, Mora, J, Fort, E, et al. (2007) Total enteral nutrition vs. total parenteral nutrition in patients with severe acute pancreatitis. Rev Esp Enferm Dig 99, 264269.
31 Van den Berghe, G, Wouters, P, Weekers, F, et al. (2001) Intensive insulin therapy in critically ill patients. N Engl J Med 345, 13591367.
32 Mizock, BA (2001) Alterations in fuel metabolism in critical illness: hyperglycaemia. Best Pract Res Clin Endocrinol Metab 15, 533551.
33 Suchner, U, Senftleben, U, Eckart, T, et al. (1996) Enteral versus parenteral nutrition: effects on gastrointestinal function and metabolism. Nutrition 12, 1322.
34 Petrov, MS & Zagainov, VE (2007) Influence of enteral versus parenteral nutrition on blood glucose control in acute pancreatitis: a systematic review. Clin Nutr 26, 514523.
35 Jolliet, P, Pichard, C, Biolo, G, et al. (1999) Enteral nutrition in intensive care patients: a practical approach. A position paper. Clin Nutr 18, 4756.
36 Wiesen, P, Van Gossum, A & Preiser, JC (2006) Diarrhoea in the critically ill. Curr Opin Crit Care 12, 149154.
37 Sabol, VK & Carlson, KK (2007) Diarrhea: applying research to bedside practice. AACN Adv Crit Care 18, 3244.
38 Whelan, K, Hill, L, Preedy, VR, et al. (2006) Formula delivery in patients receiving enteral tube feeding on general hospital wards: the impact of nasogastric extubation and diarrhea. Nutrition 22, 10251031.
39 Majid, HA, Emery, PW & Whelan, K (2008) Attitudes of patients and nurses towards diarrhoea during enteral tube feeding. J Hum Nutr Diet 21, 395.
40 Whelan, K (2007) Enteral-tube-feeding diarrhoea: manipulating the colonic microbiota with probiotics and prebiotics. Proc Nutr Soc 66, 299306.
41 de Boer, SY, Masclee, AA, Lam, WF, et al. (1993) Hyperglycemia modulates gallbladder motility and small intestinal transit time in man. Dig Dis Sci 38, 22282235.
42 Rayner, CK, Samsom, M, Jones, KL, et al. (2001) Relationships of upper gastrointestinal motor and sensory function with glycemic control. Diabetes Care 24, 371381.
43 Elia, M, Engfer, MB, Green, CJ, et al. (2008) Systematic review and meta-analysis: the clinical and physiological effects of fibre-containing enteral formulae. Aliment Pharmacol Ther 27, 120145.
44 Petrov, MS, Loveday, BP, Pylypchuk, RD, et al. (2009) Systematic review and meta-analysis of enteral nutrition formulations in acute pancreatitis. Br J Surg 96, 12431252.
45 Karakan, T, Ergun, M, Dogan, I, et al. (2007) Comparison of early enteral nutrition in severe acute pancreatitis with prebiotic fiber supplementation versus standard enteral solution: a prospective randomized double-blind study. World J Gastroenterol 13, 27332737.
46 Besselink, MG, van Santvoort, HC, Buskens, E, et al. (2008) Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. Lancet 371, 651659.
47 Whelan, K & Myers, CE (2010) Safety of probiotics in patients receiving nutritional support: a systematic review of case reports, randomized controlled trials and non-randomized trials. Am J Clin Nutr 91, 687703.
48 Ioannidis, JP (2009) Adverse events in randomized trials: neglected, restricted, distorted, and silenced. Arch Intern Med 169, 17371739.
49 Lebak, KJ, Bliss, DZ, Savik, K, et al. (2003) What's new on defining diarrhea in tube-feeding studies? Clin Nurs Res 12, 174204.
50 Whelan, K, Judd, PA & Taylor, MA (2003) Defining and reporting diarrhoea during enteral tube feeding: do health professionals agree? J Hum Nutr Diet 16, 2126.
51 Couse, N, Pickford, LR, Mitchell, CJ, et al. (1993) Total parenteral nutrition by peripheral vein – substitute or supplement to the central venous route? A prospective trial. Clin Nutr 12, 213216.
52 Rau, B, Schilling, MK & Beger, HG (2004) Laboratory markers of severe acute pancreatitis. Dig Dis 22, 247257.
53 Frossard, JL, Hadengue, A & Pastor, CM (2001) New serum markers for the detection of severe acute pancreatitis in humans. Am J Respir Crit Care Med 164, 162170.
54 Petrov, MS & Windsor, JA (2010) Classification of the severity of acute pancreatitis: how many categories make sense? Am J Gastroenterol 105, 7476.
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British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
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