| Severe acute pancreatitis is a critical disease involved the pancreas and other organs, and its mortality is reported in the range of 20%-40%. When SAP occurs, the patients are in a state of hypermetabolism, hypercatabolism and significant negative nitrogen balance, leading to malnutrition and poor prognosis. So, nutrition support has been an important part of comprehensive treatment of SAP, having a major impact on prognosis of SAP.Nutrition support includes total parenteral nutrition and enteral nutrition. However, TPN could improve the prognosis of SAP obviously, but long-term TPN can cause some adverse reactions, and can lead to impaired intestinal mucosal barrier function, intestinal bacterial translocation, resulting in increased intestinal infection and increased the pancreatic and systemic organ damage. In recent years, some studies suggested that, EN is more in line with physiological metabolic processes, which can effectively maintain gut barrier function, significant reduce the incidence of adverse reactions caused by TPN, so EN shows more effective than TPN for SAP; However some other studies have the opposite view. Therefore, it is still controversial that who is more effective in the treatment of SAP, EN or TPN.Enteral nutrition general can be divided into nasojejunal enteral nutrition and nasogastric enteral nutrition. NJEN is recommended in early EN, but its shortcoming is a more complex operation. In recent years, some researchers reported that compared to NJEN, NGEN having an easy operation has a similar effect on the treatment of SAP. But there is still a lack of evidence-based medical evidence.In view of these, this study tries to systematically evaluate the efficacy of EN on SAP, and further analyze the efficacy and tolerance of NGEN in SAP, by selecting randomized controlled trials, in order to offer objective basis to clinical application. Objective:To evaluate the efficacy of enteral nutrition in improving the clinical outcomes of severe acute pancreatitis.Methods:PUBMED, The Cochrane Central Register of Controlled Trials and Web of Science were searched from1966 to 2010 (up to January), Chinese Biomedical Database, Chinese Journals Full-text Database and Wan Fang Digital Journal Full-text database were searched from 1978 to 2010 (up to January), and the clinical randomized controlled trials of enteral nutrition compared with parenteral nutrition in severe acute pancreatitis were included. Two reviewers independently screened the studies 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 4.2.10.Results:Six randomized controlled trials involving 262 patients with severe acute pancreatitis met the inclusion criteria, involving 124 patients in enteral nutrition group and 138 patients in parenteral nutrition group. The results indicated that:in the nutrition support of severe acute pancreatitis, enteral nutrition reduced the risk of mortality (OR=0.37,95%CI:0.18-0.75, P =0.006), rate of surgical intervention (OR=0.30,95%CI:0.16-0.57, P=0.0003), infective complication (OR=0.20,95%CI:0.08-0.52, P=0.0008), pancreatic infections(OR=0.28,95%CI: 0.14-0.57,P=0.0005) and the risk of organ failure (OR=0.45,95%CI:0.22-0.94, P=0.03). And enteral nutrition was not superior to parenteral nutrition in shortening the length of hospital stay (WMD=-2.44,95%CI:-9.69-4.80, P=0.51).Conclusion:In nutrition support of severe acute pancreatitis, compared to parenteral nutrition, enteral nutrition can reduce the risk of mortality, surgical intervention, infective complication, pancreatic infections and the risk of organ failure, except of the length of hospital stay. Objective:To evaluate the efficacy and tolerance of nasogastric enteral nutrition in the treatment of severe acute pancreatitis.Methods:PUBMED, The Cochrane Central Register of Controlled Trials and Web of Science were searched from1966 to 2010 (up to January), Chinese Biomedical Database, Chinese Journals Full-text Database and Wan Fang Digital Journal Full-text database were searched from 1978 to 2010 (up to January), and the clinical randomized controlled trials of nasogastic enteral nutrition compared with nasojejunal enteral nutrition in severe acute pancreatitis were included. Two reviewers independently screened the studies 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 4.2.10.Results:Two randomized controlled trials involving 81 patients with severe acute pancreatitis met the inclusion criteria, involving 43 patients in nasogastric enteral nutrition group and 38 patients in nasojejunal enteral nutrition group. The results indicated that:in the nutrition support of severe acute pancreatitis, there is no significant difference between nasogastric enteral nutrition and nasojejunal enteral nutrition in the risk of mortality of SAP (OR=0.69,95%CI: 0.26-1.88, P=0.47), diarrhea associated with enteral nutrition (OR=1.63,95%CI:0.42-6.32, P=0.48), rate of tube displacement (OR=0.39,95%CI:0.07-2.29, P=0.30) and pain associated with enteral nutrition (OR=2.05,95%CI:0.29-14.63, P=0.47).Conclusion:In enteral nutrition support of severe acute pancreatitis, nasogstric enteral nutrition is comparable to nasojejunal enteral nutrition in efficacy and tolerance, but the former is more easily to operate. So there is a potential possibility to replace the latter.
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