Meta-analysis Of Enteral Nutrition Timing In Severe Acute Pancreatitis

AIM:To investigate the therapeutic effect of early enteral nutrition(within 48 hours)on severe acute pancreatitis compared with delayed enteral nutrition(48 hours later)Method : A computerized literature search of PubMed,Cochrane Library,Ovid,Wan Fang and Chinese Biomedicine databases was conducted to identify relevant articles published from January 2008 to July 2018.According to the inclusion criteria,13 studies were selected.The data were analyzed by RevMan 5.3 software.Result:We pooled 942 patients from 13 randomized controlled trials and case-control study.There were 472 patients with SAP in experimental group(EEN group)who received early enteral nutrition,and 470 patients with SAP in control group(DEN group)who received delayed enteral nutrition.Our meta-analysis shows that Early enteral nutrition in patients with SAP could reduce APACHE-II score after treatment [WMD-1.23,95%CI(-1.74,-0.72),p < 0.00001],decrease the local complications(Peripancreatic infection)[OR=0.24,95%CI(0.13,0.43),P<0.00001]and systemic complications(failure of respiration,infection)(failure of respiration [OR=0.28,95%CI(0.15,0.52),P<0.0001],infection[OR=0.36,95%CI(0.22,0.60),P<0.0001]),cut down the incidence of MODS[OR=0.40,95% CI(0.24,0.67),P=0.0005],lessen mortality rate[OR=0.39,95%CI(0.22,0.70),P=0.001],shorten the hospital stays [WMD=-10.77,95%CI(-11.62,-9.93),p<0.00001],accelerate the recovery of blood and urine amylase(blood amylase [WMD=-2.44,95%CI(-2.81,-2.07),P<0.00001],urine amylase [WMD=-4.74,95%CI(-5.29,-4.19),P<0.00001])compared with delayed enteral nutrition.It will greatly improve the prognosis of SAP patients.Conclusion:Compared with delayed enteral nutrition,early enteral nutrition(within 48 hours)could significantly reduce the incidence of MODS and mortality,reduce the incidence of local and systemic complications,cut down APACHE-II score,shorten the recovery time of blood and urine amylase,decrease hospitalization time.