Advanced enteral therapy in acute pancreatitis: is there a room for immunonutrition? A meta-analysis.

BACKGROUND It is believed that certain nutrients such as glutamine, arginine and omega-3 fatty acids may play a significant role in metabolic, inflammatory, and immune processes in acute pancreatitis. The present systematic review aimed to define whether the addition of these substances to enteral nutrition provides any clinical benefit over standard enteral formulas in patients with acute pancreatitis. METHODS A computerized search on electronic databases (Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE) and manual search of the abstracts of major gastroenterological meetings (UEGW, DDW) were undertaken. The studied outcomes were total infectious complication, in-hospital mortality and length of hospital stay. The data were meta-analyzed using a random-effects model. RESULTS A total of three randomized controlled trials satisfied the inclusion criteria. When compared with standard enteral nutrition, immunonutrition was not associated with the significantly reduced risk of total infectious complications (risk ratio 0.82; 95% confidence interval 0.44-1.53; P=0.53) and death (risk ratio 0.64; 95% confidence interval 0.20-2.07; P=0.46). Mean difference in length of hospital stay between two groups was not significant (P=0.80). CONCLUSIONS There is no evidence that enteral nutrition supplemented with glutamine, arginine and/or omega-3 fatty acids, in comparison with standard enteral nutrition, has any beneficial effect on infectious complications, mortality or length of hospital stay in acute pancreatitis. The pursuit of new compositions of enteral formulations in this category of patients may be advocated.