Systematic review and meta-analysis of enteral nutrition formulations in acute pancreatitis

Abstract Background Although the benefits of enteral nutrition in acute pancreatitis are well established, the optimal composition of enteral feeding is largely unknown. The aim of the study was to compare the tolerance and safety of enteral nutrition formulations in patients with acute pancreatitis. Methods Electronic databases (Scopus, MEDLINE, Cochrane Controlled Clinical Trials Register) and the proceedings of major pancreatology conferences were searched. Results Twenty randomized controlled trials, including 1070 patients, met the inclusion criteria. None of the following was associated with a significant difference in feeding intolerance: the use of (semi)elemental versus polymeric formulation (relative risk (RR) 0·62 (95 per cent confidence interval (c.i.) 0·10 to 3·97); P = 0·611); supplementation of enteral nutrition with probiotics (RR 0·69 (95 per cent c.i. 0·43 to 1·09); P = 0·110); or immunonutrition (RR 1·60 (95 per cent c.i. 0·31 to 8·29); P = 0·583). The risk of infectious complications and death did not differ significantly in any of the comparisons. Conclusion The use of polymeric, compared with (semi)elemental, formulation does not lead to a significantly higher risk of feeding intolerance, infectious complications or death in patients with acute pancreatitis. Neither the supplementation of enteral nutrition with probiotics nor the use of immunonutrition significantly improves the clinical outcomes.