Enteral versus parenteral nutrition following pancreaticoduodenectomy: a systematic review and meta-analysis |
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Authors: | Alfred Adiamah Reesha Ranat Dhanwant Gomez |
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Affiliation: | Department of Hepatobiliary Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen''s Medical Centre, Nottingham, NG7 2UH, United Kingdom |
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Abstract: | BackgroundThe need for nutritional support following pancreaticoduodenectomy is well recognised due to the high prevalence of malnutrition, but the optimal delivery route is still debated. This meta-analysis evaluated postoperative outcomes in patients receiving enteral or parenteral nutrition.MethodsEMBASE, MEDLINE and Cochrane databases were searched to identify randomised controlled trials comparing enteral and parenteral nutrition in patients undergoing pancreaticoduodenectomy. The primary outcome measure was delayed gastric emptying (DGE). Secondary outcome measures included length of hospital stay (LOS); postoperative pancreatic fistula (POPF); post-pancreaticoduodenectomy haemorrhage (PPH); and infective complications (IC).ResultsFive randomised controlled trials met inclusion criteria and reported on 690 patients (enteral nutrition n = 383; and parenteral nutrition n = 307). Median age was 61.5 years (interquartile range 60.1–63.6). The pooled relative risk (RR) of the primary outcome, DGE, was 0.97 (95% confidence interval (CI) 0.52–1.81, p = 0.93). There were no statistically significant difference in the secondary outcome measures of POPF (RR 1.07, 95% CI 0.42–2.76, p = 0.88); PPH (RR 0.67, 95% CI 0.31–1.48, p = 0.33) and infectious complications (RR 0.76, 95% CI 0.50–1.17, p = 0.22). However, LOS favoured enteral nutrition, weighted mean difference ?1.63 days (95% CI -2.80, ?0.46, p = 0.006).ConclusionsEN is associated with a significantly shorter LOS compared to PN in patients undergoing pancreaticoduodenectomy. |
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Keywords: | Correspondence: Dhanwant Gomez Department of Hepatobiliary and Pancreatic Surgery Queen's Medical Centre E Floor West Block Derby Road Nottingham NG7 2UH United Kingdom. |
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