Impact of nutritional support routes on mortality in acute pancreatitis: A network meta-analysis of randomized controlled trials

Ping Han Hsieh, Tsung Chieh Yang*, Enoch Yi No Kang*, Pei Chang Lee, Jiing Chyuan Luo, Yi Hsiang Huang, Ming Chih Hou, Shih Ping Huang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: Nutritional administration in acute pancreatitis (AP) management has sparked widespread discussion, yet contradictory mortality results across meta-analyses necessitate clarification. The optimal nutritional route in AP remains uncertain. Therefore, this study aimed to compare mortality among nutritional administration routes in patients with AP using consistency model. Methods: This study searched four major databases for relevant randomized controlled trials (RCTs). Two authors independently extracted and checked data and quality. Network meta-analysis was conducted for estimating risk ratios (RRs) with 95% confidence interval (CI) based on random-effects model. Subgroup analyses accounted for AP severity and nutrition support initiation. Results: A meticulous search yielded 1185 references, with 30 records meeting inclusion criteria from 27 RCTs (n = 1594). Pooled analyses showed the mortality risk reduction associated with nasogastric (NG) (RR = 0.34; 95%CI: 0.16–0.73) and nasojejunal (NJ) feeding (RR = 0.46; 95%CI: 0.25–0.84) in comparison to nil per os. Similarly, NG (RR = 0.45; 95%CI: 0.24–0.83) and NJ (RR = 0.60; 95%CI: 0.40–0.90) feeding also showed lower mortality risk than total parenteral nutrition. Subgroup analyses, stratified by severity, supported these findings. Notably, the timing of nutritional support initiation emerged as a significant factor, with NJ feeding demonstrating notable mortality reduction within 24 and 48 h, particularly in severe cases. Conclusion: For severe AP, both NG and NJ feeding appear optimal, with variations in initiation timings. NG feeding does not appear to merit recommendation within the initial 24 h, whereas NJ feeding is advisable within the corresponding timeframe following admission. These findings offer valuable insights for optimizing nutritional interventions in AP.

Original languageEnglish
Pages (from-to)759-773
Number of pages15
JournalJournal of Internal Medicine
Volume295
Issue number6
DOIs
StatePublished - Jun 2024

Keywords

  • acute pancreatitis
  • enteral feeding
  • naso-jejunal feeding
  • nasogastric feeding
  • nutritional therapy
  • total parenteral nutrition

Fingerprint

Dive into the research topics of 'Impact of nutritional support routes on mortality in acute pancreatitis: A network meta-analysis of randomized controlled trials'. Together they form a unique fingerprint.

Cite this