Early enteral nutrition versus delayed enteral nutrition in acute pancreatitis: A PRISMA-compliant systematic review and meta-analysis

BACKGROUND: Whether early enteral nutrition (EEN) administration is more beneficial than delayed enteral nutrition (DEN) for patients with acute pancreatitis remains controversial. METHODS: This meta-analysis aimed to pool all relevant articles to evaluate the effects of EEN within 48 hours versus DEN beyond 48 hours on the clinical outcomes of patients with acute pancreatitis. We searched PubMed, Scopus, Embase, and Web of Science for all relevant studies and extracted the data concerning basic characteristics, complications, and mortality. We calculated the pooled risk ratio (RR), weighted mean difference, and the corresponding 95% confidential interval (95% CI) using STATA 12.0. RESULTS: For complications, the pooled analysis showed that EEN was related to a reduced risk of multiple organ failure (RR = 0.67, 95% CI 0.46–0.99, P = .04), but not for necrotizing pancreatitis (RR = 0.95, 95% CI 0.81–1.12, P = .57). There was a tendency for decreased systemic inflammatory response syndrome in the EEN group, but the trend was not significant (RR = 0.85, 95% CI 0.71–1.02, P = .09). For mortality, no significant difference was found between the EEN and DEN groups (RR = 0.78, 95% CI 0.27–2.24, P = .64). CONCLUSION: EEN within 48 hours is superior to DEN beyond 48 hours for patients with acute pancreatitis; however, more studies are required to verify this conclusion.