CoChat
Sign Up
Cited by 45Pancreatitis Pathology and TreatmentClinical Nutrition and GastroenterologySepsis Diagnosis and Treatment

Efficacy comparisons of enteral nutrition and parenteral nutrition in patients with severe acute pancreatitis: a meta-analysis from randomized controlled trials

Open access
Wu, Ping, Li, Liang, Sun, Weijia·2018·Bioscience Reports
DOI 10.1042/bsr20181515PMC PMC6239262
Open this paper in CoChat — free account

Abstract

We conducted a comprehensive analysis to evaluate the treatment efficacy and safety of enteral nutrition (EN) and parenteral nutrition (PN) in severe acute pancreatitis (SAP) patients, and to provide a basis for their evidence based application in a clinical setting. We conducted a systematic online search of the PubMed, Web of Science, Wanfang, and China National Knowledge Infrastructure databases, from their inception to November 2017. Studies were subjected to further screening if they met the inclusion/exclusion criteria. Eleven studies were subjected to qualitative and quantitative synthesis; these included a total of 562 patients (281 for EN and 281 for PN). No significant heterogeneity across studies was found. The results indicated that EN can significantly decrease the mortality rate (relative risk [RR] = 0.43, 95% confidence interval [CI]: 0.23–0.78, P=0.006), and lowers the risk of infection and complications (RR = 0.53, 95% CI: 0.39–0.71, P=0.000) more so than does PN. The EN group had a similar risk of multiple organ failure (MOF) compared with the PN group (RR = 0.63, 95% CI: 0.39–1.02, P=0.059). The use of EN was also found to significantly reduce mean hospitalization time (mean difference = −2.93, 95% CI: −4.52–1.34, P=0.000). No publication bias was found. Our meta-analysis suggested that EN, but not PN, significantly reduced the risk of mortality, infection, and complications for patients with SAP. EN support also decreased the rate of MOF and surgical intervention. EN is recommended as an initial treatment option for patients with SAP.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1042/bsr20181515

Cites

1 of 1 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In polymorbid medical inpatients whose nutritional requirements cannot be met orally, EN may be superior to PN because of a lower risk of infectious and non-infectious complications and maintenance of gut integrity.

    “In polymorbid medical inpatients whose nutritional requirements cannot be met orally, the use of EN may be superior to PN because of a lower risk of infectious, non-infectious complications and maintenance of gut integrity.”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [60]

    The Results (Pooled results) report lower infection and overall complication rates with EN than PN, and the Discussion says EN preserves the intestinal mucosal barrier. The evidence concerns patients with severe acute pancreatitis, not polymorbid medical inpatients generally; it also does not establish a separate reduction in non-infectious complications for that broader population. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In pancreatitis, a meta-analysis of 11 trials (562 patients) found EN compared with PN was associated with decreased mortality (RR 0.43, 95% CI 0.23 to 0.78, p=0.006), lower risk of infection and complications (RR 0.53, 95% CI 0.39 to 0.71, p=0.000), and reduction in mean LOS (MD -2.93, 95% CI -4.52 to -1.34, p=0.000).

    “Similarly for pancreatitis, a metaanalysis including eleven trials and 562 patients found that compared with PN, EN was associated with decreased mortality (relative risk 0.43, 95% CI 0.23 to 0.78, p ¼ 0.006), a lower risk of infection and complications (RR 0.53, 95% CI 0.39 to 0.71, p ¼ 0.000) and a reduction in mean LOS (mean difference ¼ À2.93, 95% CI -4.52 to À1.34, p ¼ 0.000) [60].”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [60]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 34

  1. [1]Forsmark C.E., Vege S.S. and Wilcox C.M. (2016) Acute pancreatitis. N. Engl. J. Med. 375, 1972– 1981 10.1056/NEJMra1505202 27959604 PMC13220086 · DOI
  2. [2]Portelli M. and Jones C.D. (2017) Severe acute pancreatitis: pathogenesis, diagnosis and surgical management. Hepatobiliary Pancreat. Dis. Int. 16, 155– 159 10.1016/S1499-3872(16)60163-7 28381378 · DOI
  3. [3]Maheshwari R. and Subramanian R.M. (2016) Severe acute pancreatitis and necrotizing pancreatitis. Crit. Care Clin. 32, 279– 290 10.1016/j.ccc.2015.12.006 27016168 · DOI
  4. [4]Dupont B., Musikas M., Dao M.T. and Piquet M.A. (2016) Timing and route of enteral nutrition in severe acute pancreatitis? Pancreas 45, e20 10.1097/MPA.0000000000000560 27077719 · DOI
  5. [5]Peng L., Wu L.G., Li B., Zhao J. and Wen L.M. (2016) Early enteral nutrition improves intestinal immune barrier in a rat model of severe acute pancreatitis. J. Hepatobiliary Pancreat. Sci. 23, 681– 687 10.1002/jhbp.358 27168084 · DOI
  6. [6]Doley R.P., Yadav T.D., Wig J.D., Kochhar R., Singh G., Bharathy K.G. (2009) Enteral nutrition in severe acute pancreatitis. JOP 10, 157– 162 19287109
  7. [7]Vieira J.P., Araujo G.F., Azevedo J.R., Goldenberg A. and Linhares M.M. (2010) Parenteral nutrition versus enteral nutrition in severe acute pancreatitis. Acta Cir. Bras. 25, 449– 454 10.1590/S0102-86502010000500012 20877957 · DOI
  8. [8]Mutch K.L., Heidal K.B., Gross K.H. and Bertrand B. (2011) Cost-analysis of nutrition support in patients with severe acute pancreatitis. Int. J. Health Care Qual. Assur. 24, 540– 547 10.1108/09526861111160571 22204087 · DOI
  9. [9]Garcia D.C.G., Cacho A.G., Gonzalvez-Gasch A., Barba M.R., Herreros V.B. and Barbado C.A. (2008) Nasogastric enteral nutrition in severe acute pancreatitis. Med. Clin. (Barc) 130, 492– 493 18423167
  10. [10]Vieira J.P., Araujo G.F., Azevedo J.R., Goldenberg A. and Linhares M.M. (2010) Parenteral nutrition versus enteral nutrition in severe acute pancreatitis. Acta Cir. Bras. 25, 449– 454 10.1590/S0102-86502010000500012 20877957 · DOI
  11. [12]Higgins J.P., Altman D.G., Gotzsche P.C., Juni P., Moher D., Oxman A.D. (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343, d5928 10.1136/bmj.d5928 22008217 PMC3196245 · DOI · Paper page
  12. [13]Higgins J.P., Thompson S.G., Deeks J.J. and Altman D.G. (2003) Measuring inconsistency in meta-analyses. BMJ 327, 557– 560 10.1136/bmj.327.7414.557 12958120 PMC192859 · DOI · Paper page
  13. [14]Begg C.B. and Mazumdar M. (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50, 1088– 1101 10.2307/2533446 7786990 · DOI · Paper page
  14. [15]Egger M., Davey S.G., Schneider M. and Minder C. (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315, 629– 634 10.1136/bmj.315.7109.629 9310563 PMC2127453 · DOI · Paper page
  15. [16]Casas M., Mora J., Fort E., Aracil C., Busquets D., Galter S. (2007) Total enteral nutrition vs. total parenteral nutrition in patients with severe acute pancreatitis. Rev. Esp. Enferm. Dig. 99, 264– 269 10.4321/S1130-01082007000500004 17650935 · DOI
  16. [17]Doley R.P., Yadav T.D., Wig J.D., Kochhar R., Singh G., Bharathy K.G. (2009) Enteral nutrition in severe acute pancreatitis. JOP 10, 157– 162 19287109
  17. [19]Kalfarentzos F., Kehagias J., Mead N., Kokkinis K. and Gogos C.A. (1997) Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial. Br. J. Surg. 84, 1665– 1669 10.1002/bjs.1800841207 9448611 · DOI
  18. [20]Louie B.E., Noseworthy T., Hailey D., Gramlich L.M., Jacobs P. and Warnock G.L. (2005) 2004 MacLean-Mueller prize enteral or parenteral nutrition for severe pancreatitis: a randomized controlled trial and health technology assessment. Can. J. Surg. 48, 298– 306 16149365 PMC3211537
  19. [21]Petrov M.S., Kukosh M.V. and Emelyanov N.V. (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, 336– 344 10.1159/000097949 17164546 · DOI · Paper page
  20. [27]Balthazar E.J., Robinson D.L., Megibow A.J. and Ranson J.H. (1990) Acute pancreatitis: value of CT in establishing prognosis. Radiology 174, 331– 336 10.1148/radiology.174.2.2296641 2296641 · DOI
  21. [28]Poves P.I., Fabregat P.J., Garcia B.F., Jorba M.R., Figueras F.J. and Jaurrieta M.E. (2004) Early onset of organ failure is the best predictor of mortality in acute pancreatitis. Rev. Esp. Enferm. Dig. 96, 705– 713, 15537377
  22. [29]Casas M., Mora J., Fort E., Aracil C., Busquets D., Galter S. (2007) Total enteral nutrition vs. total parenteral nutrition in patients with severe acute pancreatitis. Rev. Esp. Enferm. Dig. 99, 264– 269 10.4321/S1130-01082007000500004 17650935 · DOI
  23. [30]Gianotti L., Meier R., Lobo D.N., Bassi C., Dejong C.H., Ockenga J. (2009) ESPEN Guidelines on Parenteral Nutrition: pancreas. Clin. Nutr. 28, 428– 435 10.1016/j.clnu.2009.04.003 19464771 · DOI
  24. [31]Meier R.F. and Beglinger C. (2006) Nutrition in pancreatic diseases. Best Pract. Res. Clin. Gastroenterol. 20, 507– 529 10.1016/j.bpg.2006.01.004 16782526 · DOI
  25. [32]O’Keefe S.J. and McClave S.A. (2005) Feeding the injured pancreas. Gastroenterology 129, 1129– 1130 10.1053/j.gastro.2005.06.077 16143153 · DOI
  26. [33]Yi F., Ge L., Zhao J., Lei Y., Zhou F., Chen Z. (2012) Meta-analysis: total parenteral nutrition versus total enteral nutrition in predicted severe acute pancreatitis. Intern. Med. 51, 523– 530 10.2169/internalmedicine.51.6685 22449657 · DOI
  27. [34]Quan H., Wang X. and Guo C. (2011) A meta-analysis of enteral nutrition and total parenteral nutrition in patients with acute pancreatitis. Gastroenterol Res. Pract. 2011, 698248 10.1155/2011/698248 21687619 PMC3113258 · DOI
  28. [35]Cao Y., Xu Y., Lu T., Gao F. and Mo Z. (2008) Meta-analysis of enteral nutrition versus total parenteral nutrition in patients with severe acute pancreatitis. Ann. Nutr. Metab. 53, 268– 275 10.1159/000189382 19136822 · DOI
  29. [36]Li W., Liu J., Zhao S. and Li J. (2018) Safety and efficacy of total parenteral nutrition versus total enteral nutrition for patients with severe acute pancreatitis: a meta-analysis. J. Int. Med. Res. 46, 3948– 3958 10.1177/0300060518782070 29962261 PMC6136006 · DOI
  30. [37]Kalfarentzos F.E., Karavias D.D., Karatzas T.M., Alevizatos B.A. and Androulakis J.A. (1991) Total parenteral nutrition in severe acute pancreatitis. J. Am. Coll. Nutr. 10, 156– 162 1903137
  31. [38]McClave S.A. and Dryden G.W. (2002) Issues of nutritional support for the patient with acute pancreatitis. Semin. Gastrointest. Dis. 13, 154– 160 12230318
  32. [39]Krishnan K. (2017) Nutritional management of acute pancreatitis. Curr. Opin. Gastroenterol. 33, 102– 106 28141617
  33. [40]Poropat G., Giljaca V., Hauser G. and Stimac D. (2015) Enteral nutrition formulations for acute pancreatitis. Cochrane Database Syst. Rev., 10.1002/14651858.CD010605.pub2 PMC10898221 25803695 · DOI
  34. [41]Hegazi R.A. and DeWitt T. (2014) Enteral nutrition and immune modulation of acute pancreatitis. World J. Gastroenterol. 20, 16101– 16105 25473161 PMC4239495

Cited by

Sorted by citations

Authors
Wu, P., Li, L., & Sun, W.
Affiliations
Central South University (CN)
Corresponding author
Sun, Weijia
ORCID
Venue
Bioscience Reports
Publisher
Portland Press Ltd.
Published
2018-11-16
Volume
38
Issue
6
ISSN
  • 0144-8463 (ISSN-L)
  • 1573-4935
DOI
10.1042/bsr20181515
PMC
PMC6239262
OpenAlex
W2897793376
Cited by
45
References
1
Citations by year
2026: 3 · 2025: 3 · 2024: 9 · 2023: 11 · 2022: 10 · 2021: 3 · 2020: 4 · 2019: 2
FWCI
0.50
Type
journal article
Language
en
Update notices
correction (2020-02-14)
Open access
Licence
Locations
  • Bioscience Reports (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
Xiangya Hospital, Central South University
Topics
  • Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
Keywords
enteral nutrition, parenteral nutrition, severe acute pancreatitis, mortality, infection, multiple organ failure, length of hospital stay, surgical treatment, nutritional support
MeSH terms
Acute Disease, Adult, Aged, Enteral Nutrition, Female, Humans, Male, Middle Aged, Pancreatitis, Parenteral Nutrition, Risk, Nutrition Assessment, Randomized Controlled Trials as Topic, Treatment Outcome

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review