Tolerance and efficacy of nasogastric enteral nutrition for severe acute pancreatitis: A meta-analysis

Shu-Fen FENG

ABSTRACT

Objective To evaluate the tolerance and efficacy of nasogastric enteral nutrition (NGEN) in the treatment of severe acute pancreatitis (SAP). Methods PUBMED, Web of Science and The Cochrane Central Register of Controlled Trials from 1966 to 2011 (up to October) and Chinese Journals Full-text Database (CNKI), Database for Chinese Technical Periodicals (VIP) and Wanfang Digital Journal Full-text Database from 1978 to 2011 (up to October) were retrieved to collect clinical randomized controlled trials of NGEN to compare with nasojejunal enteral nutrition (NJEN) in the treatment of SAP. Two reviewers independently screened the literature for eligibility and evaluated the quality with confirmation of cross-check. Different opinions would be decided by the third party. Statistical analysis was performed by meta-analysis using Review Manager 4.2. Results Three randomized controlled trails including 159 patients with SAP met the inclusion criteria, involving 82 patients in NGEN group and 77 in NJEN group. There was no significant difference between NGEN and NJEN group in the risk of mortality of SAP (RR=0.69, 95%CI: 0.37-1.29, P=0.25), conversion to surgery (RR=2.09, 95% CI: 0.55-7.92, P=0.28), diarrhea subsequent to enteral nutrition (RR=1.43, 95% CI: 0.59-3.45, P=0.43), rate of tube displacement (RR=0.42, 95%CI: 0.08-2.17, P=0.30) and pain related with enteral nutrition (RR=0.94, 95%CI: 0.32-2.70, P=0.90). While compared with NJEN, the risk of infectious complications was lower than NGEN (RR=0.64, 95%CI: 0.42-0.99, P=0.04). Conclusion In enteral nutrition support of SAP, NGEN is comparable to NJEN in efficacy and tolerance, but the former has the lower rate of infectious complications and easier to operate, and there is a tendency of NEGN to replace the latter.