The Efficacy Of Oral Versus Nasal Feeding In The Early Stage Of Acute Pancreatitis:a Meta-analysis

Background and objective:Acute pancreatitis is one of the most common digestive tract diseases,and nutritional support therapy is the inevitable treatment for acute pancreatitis.Enteral nutrition support through nasal feeding tube is the main mode of enteral nutrition advocated today,while early oral feeding is a new mode of nutrition support proposed in recent years for enteral nutrition of AP patients,which is safe and reliable in theory.The purpose of this study was to conduct a meta-analysis by searching and collecting a large number of relevant articles published at home and abroad,to evaluate the advantages and disadvantages of early oral feeding versus nasal feeding tube in AP patients,and to provide guidance for front-line clinicians in the selection of early nutritional methods for AP patients.Methods:Literature collected in CNKI,Sino Med,Wanfang,VIP,Pub Med,Embase,Web of Science,Cochrane Library,Medline,etc.by December 2022 were retrieved,and the required information was extracted from those that met the requirements.The Rev Man 5.3 software was used to analyze to related indicators.Results:A total of 10 literatures were included in the study,among which 5 were RCTS and 5 were NRCT.After they were grouped,the Rev Man 5.3 software was used for summary analysis.In terms of mortality,there was no difference between the two groups [RCT group: RR=1.08,95%CI(0.52,2.26),P=0.83;NRCT group: RR=1.08,95%CI(0.48,2.44),P=0.85];There was no difference in the rate of abdominal infection between the two groups [RCT group: RR=0.83,95%CI(0.56,1.23),P=0.36;In the NRCT group,RR=0.97,95%CI(0.58,1.62),P=0.92];In terms of enteral nutrition-related complications,the RCT group showed that oral feeding reduced the incidence of complications [RR=0.23,95%CI(0.13,0.41),P < 0.00001],while the NRCT group showed no difference [RR=0.94,95%CI(0.74,1.18),P = 0.58];There was no difference in the rate of surgical intervention,the incidence of ARDS or ARF.In terms of length of hospital stay,both the RCT group and the NRCT group showed that oral feeding reduced length of hospital stay [RCT group :SMD=-6.97,95%CI(-8.40,-5.54),P < 0.00001;NRCT group: SMD=-3.60,95%CI(-6.78,-0.43),P=0.03];The hospitalization costs of oral feeding was lower than that of nasal feeding patients,but there was no significant difference.Conclusions:Compared with nasal feeding,early oral feeding in AP patients should be safe,and does not increase the mortality rate,peritoneal infection rate,surgical intervention rate,ARDS or ARF of patients.In terms of efficacy,it can reduce the length of hospital stay of patients obviously,and may reduce the hospitalization costs of patients.Therefore,for AP patients,we recommend early oral feeding over nasal feeding.