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Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis

BMJ 2004; 328 doi: (Published 10 June 2004) Cite this as: BMJ 2004;328:1407
  1. Paul E Marik, professor of critical care medicine (maripe{at},
  2. Gary P Zaloga, medical director2
  1. 1Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
  2. 2Methodist Research Institute, Indianapolis, IN 46202, USA
  1. Correspondence to: P Marik
  • Accepted 2 April 2004


Objective To compare the safety and clinical outcomes of enteral and parenteral nutrition in patients with acute pancreatitis.

Data sources Medline, Embase, Cochrane controlled trials register, and citation review of relevant primary and review articles.

Study selection Randomised 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 extraction Six 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 synthesis Enteral 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.

Conclusions Enteral nutrition should be the preferred route of nutritional support in patients with acute pancreatitis.


  • Contributors Both authors selected studies, extracted and analysed data, and wrote the paper. PEM is guarantor.

  • Funding None.

  • Competing interests None declared.

  • Ethical approval Not required.

  • Accepted 2 April 2004
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