Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University.
Pancreatic Disease Center, Xi'an Peoples Hospital.
J Clin Gastroenterol. 2024;58(5):522-530. doi: 10.1097/MCG.0000000000001886. Epub 2023 Jul 10.
The aim of this study was to summarize the optimal strategy for early feeding in patients with acute pancreatitis.
The search was undertaken in electronic databases, which compared early with delayed feeding in acute pancreatitis. The primary outcome was the length of hospital stay (LOHS). The second outcomes were intolerance of refeeding, mortality, and total cost of each patient. This meta-analysis followed the "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guideline. Research is registered by PROSPERO, CRD42020192133.
A total of 20 trials involving 2168 patients were included, randomly assigned to the early feeding group (N = 1033) and delayed feeding group (N = 1135). The LOHS was significantly lower in the early feeding group than the delayed feeding group (mean difference: -2.35, 95% CI: -2.89 to -1.80; P < 0.0001), no matter the mild or severe subgroup ( Pint = 0.69). The secondary outcome of feeding intolerance and mortality were no significant difference (risk ratio: 0.96, 0.40 to 2.16, P = 0.87 and 0.91, 0.57 to 1.46, P = 0.69; respectively). Moreover, the hospitalization cost was significantly less in the early feeding group, resulting in an average savings of 50%. In patients with severe pancreatitis, early feeding after 24 hours may be beneficial ( Pint = 0.001).
Early oral feeding can significantly reduce the LOHS and hospitalization costs in patients with acute pancreatitis without increasing feeding intolerance or mortality. In patients with severe pancreatitis, early feeding after 24 hours may be beneficial.
本研究旨在总结急性胰腺炎患者早期喂养的最佳策略。
我们在电子数据库中进行了检索，比较了急性胰腺炎患者的早期喂养和延迟喂养。主要结局是住院时间（LOHS）。次要结局是再喂养不耐受、死亡率和每位患者的总费用。本荟萃分析遵循“系统评价和荟萃分析的首选报告项目”指南。研究已在 PROSPERO 上注册，CRD42020192133。
共有 20 项试验（涉及 2168 名患者）纳入本研究，随机分为早期喂养组（N=1033）和延迟喂养组（N=1135）。早期喂养组的 LOHS 明显低于延迟喂养组（平均差：-2.35，95%CI：-2.89 至-1.80；P<0.0001），无论轻、重症亚组（Pint=0.69）。再喂养不耐受和死亡率的次要结局无显著差异（风险比：0.96，0.40 至 2.16，P=0.87 和 0.91，0.57 至 1.46，P=0.69；分别）。此外，早期喂养组的住院费用显著降低，平均节省 50%。对于重症胰腺炎患者，24 小时后早期喂养可能有益（Pint=0.001）。
早期口服喂养可显著缩短急性胰腺炎患者的 LOHS 和住院时间，且不会增加再喂养不耐受或死亡率。对于重症胰腺炎患者，24 小时后早期喂养可能有益。
