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A Meta-analysis of Randomized Trials

Maxim S. Petrov, MD; Hjalmar C. van Santvoort, MD; Marc G. H. Besselink, MD; Geert J. M. G. van der Heijden, PhD; John A. Windsor, MD, FRACS; Hein G. Gooszen, MD, PhD

Arch Surg. 2008;143(11):1111-1117.

Objective  To compare the effect of enteral vs parenteral nutrition in patients with severe acute pancreatitis for clinically relevant outcomes.

Data Sources  A computerized literature search was performed in the MEDLINE, EMBASE, and Cochrane databases for articles published from January 1, 1966, until December 15, 2006.

Study Selection  From 253 publications screened, 5 randomized controlled trials comparing enteral and parenteral nutrition in patients with predicted severe acute pancreatitis met the inclusion criteria.

Data Extraction  Information on study design, patient characteristics, and acute pancreatitis outcomes were independently extracted by two of us using a standardized protocol.

Data Synthesis  A 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).

Conclusions  Enteral nutrition results in clinically relevant and statistically significant risk reduction for infectious complications, pancreatic infections, and mortality in patients with predicted severe acute pancreatitis.

Author Affiliations: Department of Surgery (Drs Petrov, van Santvoort, Besselink, and Gooszen) and Julius Center for Health Sciences and Primary Care (Dr van der Heijden), University Medical Center Utrecht, Utrecht, the Netherlands; and Department of Surgery, University of Auckland, Auckland, New Zealand (Dr Windsor).

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