• Paul E Marik and Gary P Zaloga.
• Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA. maripe@ccm.upmc.edu
• BMJ. 2004 Jun 12; 328 (7453): 1407.

ObjectiveTo compare the safety and clinical outcomes of enteral and parenteral nutrition in patients with acute pancreatitis.Data SourcesMedline, Embase, Cochrane controlled trials register, and citation review of relevant primary and review articles.Study SelectionRandomised controlled studies that compared enteral nutrition with parenteral nutrition in patients with acute pancreatitis. From 117 articles screened, six were identified as randomised controlled trials and were included for data extraction.Data ExtractionSix studies with 263 participants were analysed. Descriptive and outcome data were extracted. Main outcome measures were infections, complications other than infections, operative interventions, length of hospital stay, and mortality. The meta-analysis was performed with the random effects model.Data SynthesisEnteral nutrition was associated with a significantly lower incidence of infections (relative risk 0.45; 95% confidence interval 0.26 to 0.78, P = 0.004), reduced surgical interventions to control pancreatitis (0.48, 0.22 to 1.0, P = 0.05), and a reduced length of hospital stay (mean reduction 2.9 days, 1.6 days to 4.3 days, P < 0.001). There were no significant differences in mortality (relative risk 0.66, 0.32 to 1.37, P = 0.3) or non-infectious complications (0.61, 0.31 to 1.22, P = 0.16) between the two groups of patients.ConclusionsEnteral nutrition should be the preferred route of nutritional support in patients with acute pancreatitis.

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