Influence of enteral versus parenteral nutrition on blood glucose control in acute pancreatitis: a systematic review.

BACKGROUND & AIMS There is increasing evidence that tight glucose control may reduce infectious complications and mortality in surgical critically ill patients. However, data regarding the influence of artificial nutrition on glycemic homeostasis are limited. Our aim was to review all randomized controlled trials on enteral versus parenteral nutrition in acute pancreatitis to determine whether the route of feeding can affect the glucose control in the setting of this disease. METHODS Relevant literature cited in three electronic databases (Cochrane Central Register of Controlled Trials, EMBASE and Medline) were systematically reviewed. A meta-analysis was carried out using a random-effects model. RESULTS Thirteen randomized controlled trials on enteral versus parenteral nutrition in acute pancreatitis were identified. Seven studies were excluded from analysis, leaving 6 trials in which a total of 264 non-diabetic patients with acute pancreatitis were treated. Intake of nutrients did not differ among enterally and parenterally fed patients in 5 of 6 randomized controlled trials. Enteral nutrition reduced the risk of hyperglycemia (relative risk 0.53; 95% confidence interval 0.29-0.98; p = 0.04) and insulin requirement (relative risk 0.41; 95% confidence interval 0.24-0.70; p = 0.001). CONCLUSIONS Enteral nutrition, when compared with parenteral nutrition, is associated with better blood glucose control in patients with acute pancreatitis.