Meta-analysis Of The Effect Of Enteral Nutrition By Nasojejunal Tube Versus Nasogastric Tube In Severe Acute Pancreatitis

Objective: Severe acute pancreatitis(SAP)is a common critical illness that seriously affects people’s health and causes a huge economic burden.Patients with SAP are in a state of high catabolism,high metabolism and high nutritional requirements;therefore,nutritional support is extremely important for SAP patients and is the cornerstone of SAP treatment.This study used Meta-analysis to evaluate the effect of enteral nutrition(EN)by nasojejunal tube versus nasogastric tube in SAP.Methods: Randomized controlled trials(RCTs)on the effect of enteral nutrition in SAP by nasojejunal tube versus nasogastric tube were searched in several online databases at home and abroad,including EMBase,Pub Med,the Cochrane Library,Web of Science,Wanfang Data Knowledge Service Platform(Wan Fang Data),China National Knowledge Internet(CNKI),Chinese biomedical literature service system(Sino Med)and China Science and Technology Journal Database(VIP),using a combination of subject terms and free words,with the search period from the time of creation of the database to December 30,2022.Patients in the observation group were given enteral nutrition by nasojejunal tube and patients in the control group were given enteral nutrition by nasogastric tube.We use Rev Man 5.3 and Stata 12.0 to perform the Meta-analysis.Results: A total of 11 literatures with 645 patients were included in this study.The outcomes of Meta-analysis demonstrated that in the observation group,the incidence of gastrointestinal complications was lower(RR=0.63,95% CI 0.43～0.92,Z=2.41,P=0.02)and the serum Alb level after one week was higher(SMD=0.24,95% CI 0.01～0.46,Z=2.08,P=0.04)than that in the control group,and the mortality rate(RR=0.94,95% CI 0.56～1.58,Z=0.23,P=0.82),the incidence of infection complications(RR=0.92,95% CI 0.47～1.79,Z=0.25,P=0.80),the incidence of organ failure(RR=1.02,95% CI 0.82～1.27,Z=0.16,P=0.87),the incidence of tracheal aspiration(RR=0.33,95% CI0.07～1.51,Z=1.42,P=0.15),the length of hospital stay(SMD=-0.35,95% CI-0.80～0.09,Z=1.55,P=0.12),the serum CRP level after one week(SMD=-0.20,95% CI-0.46～0.06,Z=1.53,P=0.13)and the serum PA level after one week(SMD=-0.23,95% CI-1.28～0.82,Z=0.43,P=0.67)in the two groups were not statistically significant differences.Conclusion: 1.Transnasojejunal tube nutrition has a lower incidence of gastrointestinal complications than transnasogastric tube nutrition in patients with SAP,helping to reduce the number of gastrointestinal symptoms experienced by patients during the nutrition process;2.Transnasojejunal tube nutrition has a better ability to increase serum albumin levels in SAP patients than transnasogastric tube nutrition,which is conducive to improving patients’ nutritional status and prognosis;3.There is no adequate evidence to demonstrate the differences in safety between transnasojejunal tube nutrition and transnasogastric tube nutrition in patients with SAP.