• Maxim S Petrov, Hjalmar C van Santvoort, Marc G H Besselink, Geert J M G van der Heijden, John A Windsor, and Hein G Gooszen.
• University Medical Center Utrecht, PO Box 85500, HP G04.228, 3508 GA Utrecht, The Netherlands.
• Arch Surg. 2008 Nov 1; 143 (11): 1111-7.

ObjectiveTo compare the effect of enteral vs parenteral nutrition in patients with severe acute pancreatitis for clinically relevant outcomes.Data SourcesA computerized literature search was performed in the MEDLINE, EMBASE, and Cochrane databases for articles published from January 1, 1966, until December 15, 2006.Study SelectionFrom 253 publications screened, 5 randomized controlled trials comparing enteral and parenteral nutrition in patients with predicted severe acute pancreatitis met the inclusion criteria.Data ExtractionInformation on study design, patient characteristics, and acute pancreatitis outcomes were independently extracted by two of us using a standardized protocol.Data SynthesisA meta-analysis of randomized controlled trials was performed using a random-effects model. Enteral feeding reduced the risk of infectious complications (relative risk, 0.47; 95% confidence interval, 0.28-0.77; P < .001), pancreatic infections (0.48; 0.26-0.91; P = .02), and mortality (0.32; 0.11-0.98; P = .03). The risk reduction for organ failure was not statistically significant (0.67; 0.30-1.52; P = .34).ConclusionsEnteral nutrition results in clinically relevant and statistically significant risk reduction for infectious complications, pancreatic infections, and mortality in patients with predicted severe acute pancreatitis.

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