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This article has been cited by other articles in PMC. Two reviewers assessed the quality of each trial and collected data independently. Three RCTs were included, involving patients.

The baselines of each trial were comparable. Based on current studies, early NGEN appears effective and safe. Before recommendation to clinical practice, further high qualified, large scale, randomized lei 5260 de 2008 trials are needed.

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However, severe acute pancreatitis SAP is complicated by systemic inflammatory response syndrome SIRSleading to hypermetabolism and high protein catabolism[ 3 ]. Acute malnutrition is expected to increase morbidity and mortality due to impaired immune function, increased risk of sepsis, poor wound healing, and multiple organ failure[ 3 ].

Thus, current therapy for AP has shifted to intensive medical care, nutrition support, infection control and medicine administration, while early invasive intervention as surgery has been reserved for defined clinical indication[ 56 ].

Nutritional management for AP is an important issue and regarded as an indispensable approach. Lei 5260 de 2008 or enteral feeding may be harmful in AP and is thought to stimulate exocrine pancreatic secretion and consequently autodigestive process[ 4 ]. Up to the mid s, total parenteral nutrition TPN and gastrointestinal tract rest have been comprehensively recommended in the acute phase of pancreatitis, which make pancreas at rest to reduce pancreatic exocrine secretion and lei 5260 de 2008 meet nutritional need[ 67 ].

Intestinal mucosa atrophies during fasting as TPN phase, which would induce bacteria translocation in gastrointestinal tract and cause pancreatic necrotic tissue infection[ 8 ].

Early nasogastric enteral nutrition for severe acute pancreatitis: A systematic review

Animal experiments and several human studies have shown that enteral nutrition EN is safe and can preserve the integrity of intestinal mucosa lei 5260 de 2008 decrease the incidence of infectious complications and other severe complications, such as multiple organ deficiency syndrome MODS [ 8 - 10 ].

Furthermore, Lei 5260 de 2008 does not stimulate pancreatic exocrine secretion, if the feeding tube is positioned in the jejunum by nasojejunal or jejunostomy routes[ 811 ].

Recently, some researchers have considered the feasibility of EN through nasogastric NG tube to improve the nutrition status of patients with AP in the early phase[ 712 ]. However, this breakthrough is potentially opposing to the requirement of pancreatic rest in the acute inflammation phase.


The present study lei 5260 de 2008 to confirm whether nasogastric EN is safe and effective for patients with AP. There was no limitation of publication language. Inclusion and exclusion criteria Only randomized controlled trials were eligible. Any etiology was eligible, and there was no limitation of age, race, and sex distribution.

Comparator intervention was considered an early enteral nutritional route through nasogastric tube NGENwhile control intervention was considered one of the conventional pancreatic-rest nutritional support routes, such as total parenteral nutrition TPN or enteral nutrition by nasojejunal tube NJEN or lei 5260 de 2008 tube JSEN.

Additionally, other combined treatments included gastrointestinal decompression, prophylactic antibiotics, fluid management, artificial ventilation or renal replacement therapy for MODS, endoscopic lei 5260 de 2008 cholangio-pancreatography with endoscopic sphincterotomy for selected biliary patients, and surgery for indicated patients.

The primary outcome measure of effectiveness was overall mortality, the secondary outcome measures of effectiveness was hospital stay, complications and their management, while the outcome measures of safety included re-feeding pain recurrence and adverse events related to nasogastric enteral nutrition.

Quality assessment and data collection To evaluate the methodological quality of included studies, two reviewers Jiang K and Chen XZ assessed the quality of methods used in studies independently. According to the Cochrane Handbook for Systematic Review 4. The criteria proposed by Jadad et al[ 14 ] were also used to evaluate the quality of trials.

Data were collected by the two reviewers independently, including study sample number of each arminterventions nutrition management, approach and regimens and outcomes overall mortality, time of hospital stay, complications of systematic or local infection, or MODS defined as failure in no less than 2 organs, re-feeding pain defined as pain requiring discontinuation of feeding, elevated serum amylase levels at least two-fold higher than normal[ 7 ], and adverse events related lei 5260 de 2008 nutritionas well as the publication year and country of studies, and the number of withdrawals and dropouts and the reasons.

Any disagreement in quality assessment and data collection was discussed lei 5260 de 2008 solved by a third reviewer as the referee.