Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2010 Jan 20;2010(1):CD002837.
doi: 10.1002/14651858.CD002837.pub2.

Enteral versus parenteral nutrition for acute pancreatitis

Mohammed Al-Omran  1 , Zaina H Albalawi, Mariam F Tashkandi, Lubna A Al-Ansary
Affiliations
Meta-Analysis

Enteral versus parenteral nutrition for acute pancreatitis

Mohammed Al-Omran et al. Cochrane Database Syst Rev. .

Abstract

Background: Acute pancreatitis creates a catabolic stress state promoting a systemic inflammatory response and nutritional deterioration. Adequate supply of nutrients plays an important role in recovery. Total parenteral nutrition (TPN) has been standard practice for providing exogenous nutrients to patients with severe acute pancreatitis. However, recent data suggest that enteral nutrition (EN) is not only feasible, but safer and more effective.Therefore, we sought to update our systematic review to re-evaluate the level of evidence.

Objectives: To compare the effect of TPN versus EN on mortality, morbidity and length of hospital stay in patients with acute pancreatitis.

Search strategy: Trials were identified by computerized searches of The Cochrane Controlled Trials Register, MEDLINE, and EMBASE. Additional studies were identified by searching Scisearch, bibliographies of review articles and identified trials. The search was undertaken in August 2000 and updated in September 2002, October 2003, November 2004 and November 2008. No language restrictions were applied.

Selection criteria: Randomized clinical trials comparing TPN to EN in patients with acute pancreatitis.

Data collection and analysis: Two reviewers independently abstracted data and assessed trial quality. A standardized form was used to extract relevant data.

Main results: Eight trials with a total of 348 participants were included. Comparing EN to TPN for acute pancreatitis, the relative risk (RR) for death was 0.50 (95% CI 0.28 to 0.91), for multiple organ failure (MOF) was 0.55 (95% CI 0.37 to 0.81), for systemic infection was 0.39 (95% CI 0.23 to 0.65), for operative interventions was 0.44 (95% CI 0.29 to 0.67), for local septic complications was 0.74 (95% CI 0.40 to 1.35), and for other local complications was 0.70 (95% CI 0.43 to 1.13). Mean length of hospital stay was reduced by 2.37 days in EN vs TPN groups (95% CI -7.18 to 2.44). Furthermore, a subgroup analysis for EN vs TPN in patients with severe acute pancreatitis showed a RR for death of 0.18 (95% CI 0.06 to 0.58) and a RR for MOF of 0.46 (95% CI 0.16 to 1.29).

Authors' conclusions: In patients with acute pancreatitis, enteral nutrition significantly reduced mortality, multiple organ failure, systemic infections, and the need for operative interventions compared to those who received TPN. In addition, there was a trend towards a reduction in length of hospital stay. These data suggest that EN should be considered the standard of care for patients with acute pancreatitis requiring nutritional support.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
3
3
Forest plot of comparison: 1 Enteral versus parenteral nutrition for acute pancreatitis, outcome: 1.1 Mortality.
4
4
Forest plot of comparison: 1 Enteral versus parenteral nutrition for acute pancreatitis, outcome: 1.2 Mortality in patients with acute pancreatitis excluding those from (Kalfarentzos 1997) in which death resulted after resolution of acute pancreatitis and was attributed to other causes; cardiac surgery, cancer of the liver, squamous cell carcinoma of the pharynx and intracerebral hemorrhage..
5
5
Forest plot of comparison: 1 Enteral versus parenteral nutrition for acute pancreatitis, outcome: 1.2 Mortality in patients with severe acute pancreatitis (SAP).
6
6
Forest plot of comparison: 2 Enteral versus parenteral nutrition for acute pancreatitis, outcome: 2.1 Length of hospital stay.
7
7
Forest plot of comparison: 2 Enteral versus parenteral nutrition for acute pancreatitis, outcome: 2.2 Subgroup analysis for length of hospital stay in patients with severe acute pancreatitis.
8
8
Forest plot of comparison: 3 Enteral versus parenteral nutrition for acute pancreatitis, outcome: 3.1 Systemic Inflammatory Response Response (SIRS).
9
9
Forest plot of comparison: 4 Enteral versus parenteral nutrition for acute pancreatitis, outcome: 4.1 Multiple Organ Failure(MOF).
10
10
Forest plot of comparison: 4 Enteral versus parenteral nutrition for acute pancreatitis, outcome: 4.2 MOF in Severe Acute Pancreatitis.
11
11
Forest plot of comparison: 5 Enteral versus parenteral nutrition for acute pancreatitis, outcome: 5.1 Operative Intervention.
12
12
Forest plot of comparison: 5 Enteral versus parenteral nutrition for acute pancreatitis, outcome: 5.2 Operative intervention in SAP.
13
13
Forest plot of comparison: 6 Enteral versus parenteral nutrition for acute pancreatitis, outcome: 6.1 Systemic infection.
14
14
Forest plot of comparison: 6 Enteral versus parenteral nutrition for acute pancreatitis, outcome: 6.2 Systemic infection in SAP.
15
15
Forest plot of comparison: 7 Enteral versus parenteral nutrition for acute pancreatitis, outcome: 7.1 Local septic complications.
16
16
Forest plot of comparison: 7 Enteral versus parenteral nutrition for acute pancreatitis, outcome: 7.2 Local septic complications in SAP.
17
17
Forest plot of comparison: 8 Enteral versus parenteral nutrition for acute pancreatitis, outcome: 8.1 Other local complications.
18
18
Forest plot of comparison: 8 Enteral versus parenteral nutrition for acute pancreatitis, outcome: 8.2 Other local complications in SAP.
1.1
1.1. Analysis
Comparison 1 Enteral versus parenteral nutrition for acute pancreatitis, Outcome 1 Mortality.
1.2
1.2. Analysis
Comparison 1 Enteral versus parenteral nutrition for acute pancreatitis, Outcome 2 Mortality in patients with acute pancreatitis excluding those from (Abou‐Assi 2002) in which death resulted after resolution of acute pancreatitis and was attributed to other causes; cardiac surgery, cancer of the liver, squamous cell carcinoma of the pharynx and intracerebral hemorrhage..
1.3
1.3. Analysis
Comparison 1 Enteral versus parenteral nutrition for acute pancreatitis, Outcome 3 Mortality in patients with severe acute pancreatitis (SAP).
2.1
2.1. Analysis
Comparison 2 Enteral versus parenteral nutrition for acute pancreatitis, Outcome 1 Length of hospital stay.
2.2
2.2. Analysis
Comparison 2 Enteral versus parenteral nutrition for acute pancreatitis, Outcome 2 Subgroup analysis for length of hospital stay in patients with severe acute pancreatitis.
3.1
3.1. Analysis
Comparison 3 Enteral versus parenteral nutrition for acute pancreatitis, Outcome 1 Systemic Inflammatory Response Response Syndrome(SIRS).
4.1
4.1. Analysis
Comparison 4 Enteral versus parenteral nutrition for acute pancreatitis, Outcome 1 Multiple Organ Failure(MOF).
4.2
4.2. Analysis
Comparison 4 Enteral versus parenteral nutrition for acute pancreatitis, Outcome 2 MOF in Severe Acute Pancreatitis.
5.1
5.1. Analysis
Comparison 5 Enteral versus parenteral nutrition for acute pancreatitis, Outcome 1 Operative Intervention.
5.2
5.2. Analysis
Comparison 5 Enteral versus parenteral nutrition for acute pancreatitis, Outcome 2 Operative intervention in SAP.
6.1
6.1. Analysis
Comparison 6 Enteral versus parenteral nutrition for acute pancreatitis, Outcome 1 Systemic infection.
6.2
6.2. Analysis
Comparison 6 Enteral versus parenteral nutrition for acute pancreatitis, Outcome 2 Systemic infection in SAP.
7.1
7.1. Analysis
Comparison 7 Enteral versus parenteral nutrition for acute pancreatitis, Outcome 1 Local septic complications.
7.2
7.2. Analysis
Comparison 7 Enteral versus parenteral nutrition for acute pancreatitis, Outcome 2 Local septic complications in SAP.
8.1
8.1. Analysis
Comparison 8 Enteral versus parenteral nutrition for acute pancreatitis, Outcome 1 Other local complications.
8.2
8.2. Analysis
Comparison 8 Enteral versus parenteral nutrition for acute pancreatitis, Outcome 2 Other local complications in SAP.
See this image and copyright information in PMC

Update of

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Abou‐Assi 2002 {published data only}
    1. Abou‐Assi S, Craig K, O’Keefe SJD. Hypocaloric jejunal feeding is better than total parenteral nutrition in acute pancreatitis: Results of a randomized comparative study. American Journal of Gastroenterology 2002;97:2255‐62. - PubMed
Casas 2007 {published data only}
    1. Casas M, Mora J, Fort E, Aracil C, Busquets D, Galter S, Jáuregui CE, Ayala E, Cardona D, Gich I, Farré A. Total enteral nutrition v.s total parenteral nutrition in patients with severe acute pancreatitis. Revista Española de Enfermedades Digestivas 2007;99(5):264‐269. - PubMed
Gupta 2003 {published data only}
    1. Gupta R, Patel K, Calder PC, Yaqoob P, Primrose JN, Johnson CD. A randomised clinical trial to assess the effect of total enteral and total parenteral nutritional support on metabolic, inflammatory and oxidative markers in patients with predicted severe acute pancreatitis (APACHE II ≥6). Pancreatology 2003;3:406‐13. - PubMed
Kalfarentzos 1997 {published data only}
    1. Kalfarentzos F, Kehagias J, Mead N, Kokkinis K, Gogos CA. Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial. British Journal of Surgery 1997;84:1665‐1669. - PubMed
Louie 2005 {published data only}
    1. Louie BE, Noseworthy T, Hailey D, Gramlich LM, Jacobs P, Warnock GL. 2004 MacLean–Mueller Prize enteral or parenteral nutrition for severe pancreatitis: A randomized controlled trial and health technology assessment. Canadian Journal of Surgery 2005;48:298‐306. - PMC - PubMed
McClave 1997 {published data only}
    1. McClave SA, Greene LM, Snider HL, Mark LJK, Cheadle WG, Owens NA, Dukes LG, Goldsmith LJ. Comparison of the safety of early enteral versus parenteral nutrition in mild acute pancreatitis. Journal of Parenteral and Enteral Nutrition 1997;21:14‐20. - PubMed
Olah 2002 {published data only}
    1. Olah A, Pardavi G, Belagyi T, Nagy A, Issekutz A, Mohamed GE. Early nasojejunal feeding in acute pancreatitis is associated with a lower complication rate. Nutrition 2002;18:259‐262. - PubMed
Petrov 2006 {published data only}
    1. Petrov MS, Kukosh MV, Emelyanov NV. A Randomized controlled trial of enteral versus parenteral feeding in patients with predicted severe acute pancreatitis shows a significant reduction in mortality and in infected pancreatic complications with total enteral nutrition. Digestive Surgery 2006;23:336‐345. - PubMed

References to studies excluded from this review

Bao 2006 {published data only}
    1. Bao J, Jing D, Wang P, Wang X. Effects of early jejunum nutrition on the comprehensive therapy for severe acute pancreatitis. Chinese Journal of Gastroenterology 2006;11(5):259‐62.
Eckerwall 2006 {published data only}
    1. Eckerwall GE, Axelsson JB, Andersson RG. Early nasogastric feeding in predicted severe acute pancreatitis a clinical, randomized study. Annals of Surgery December 2006;244:959‐965. - PMC - PubMed
Hernandez‐Aranda1996 {published data only}
    1. Herandez‐Aranda JC, Gallo‐Chio B, Ramirez‐Barba EJ. Nutritional support in severe acute pancreatitis. Controlled clinical trial [Apoyo nuttricional en pancreatitis aguda grave. Ensayo clinico controlado]. Nutricion Hospitalaria 1996;11:160‐166. - PubMed
Modena 2006 {published data only}
    1. Modena JT, Cevasco LB, Basot CA, Vicuna AO, Ramirez MP. Total enteral nutrition as prophylactic therapy for pancreatic necrosis infection in severe acute pancreatitis. Pancreatology 2006;6:58‐64. - PubMed
Powell 2000 {published data only}
    1. Powell JJ, Murchison JT, Fearon KCH, Ros JA, Siriwardena AK. Randomized controlled trial of the effect of early enteral nutrition on markers of the inflammatory response in predicted severe acute pancreatitis. British Journal of Surgery 2000;87:1375‐81. - PubMed
Windsor 1996 {published data only}
    1. Windsor ACJ, Li A, Guthrie A, Barnes E, Somers SS, Welsh F, Guillou PJ, Reynolds JV. Feeding the gut in acute pancreatitis: a randomized clinical trial of enteral versus parenteral nutrition. British Journal of Surgery 1996;83:689.
Windsor 1998 {published data only}
    1. Windsor ACJ, Kanwar S, Li AGK, Barnes E, Guthrie JA, Spark JI, Welsh F, Guillou PJ, Reynolds JV. Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut 1998;42:431‐435. - PMC - PubMed
Ye 2007 {published data only}
    1. Ye P, Wu W, Liu J, Xu K. Early enteral nutrition in the treatment of acute pancreatitis. Chinese Journal of Gastroenterology 2007;12(7):411‐3.

Additional references

Alexender 1980
    1. Alexender JW, MacMillan BG, Stinnert JD. Beneficial effects of aggressive protein feeding in severely burned children. Surgery 1980;192:505‐18. - PMC - PubMed
Ammori 1999
    1. Ammori BJ, Leeder PC, King RF, Barclay GR, Martin IG, Larvin M, McMahon MJ. Early increase in intestinal permeability in patients with severe acute pancreatitis: correlation with endotoxemia, organ failure, and mortality. Journal of Gastrointestinal Surgery 1999;3:252‐62. - PubMed
Balthazar 1990
    1. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JHC. Acute pancreatitis: value of CT scan in establishing prognosis. Radiology 1990;174:331‐6. - PubMed
Banks 2006
    1. Banks PA, Freeman ML, and the Practice Parameters Committee of the American College of Gastroenterology. Practice Guidelines in Acute Pancreatitis. American Journal of Gastroenterology 2006;101:2379‐2400. - PubMed
Blamey 1984
    1. Blamey SL, Imrie CW, O'Neill J, Gilmour WH, Carter DC. Prognostic factors in acute pancreatitis. Gut 1984;25:1304‐6. - PMC - PubMed
Bradley 1993
    1. Bradley EL III. A clinically based classification system for acute pancreatitis. Summary of the International Symposium of Acute Pancreatitis, Atlanta, Ga, September 11‐13. Arch Surg 1993;128:586‐90. - PubMed
British Society of Gastroenterology 2005
    1. British Society of Gastroenterology. United Kingdom guidelines for the management of acute pancreatitis. Gut 2005;54:1‐9. - PMC - PubMed
Buchman 1995
    1. Buchman AL, Moukarazel AA, Bhuta S, Belle M, Ament ME, Eckhert CD, Hollander D, Gornbein J, Kopple JD, Vijayaroghavan SR. Parenteral nutrition is associated with intestinal morphologic and functional changes in humans. Journal of Parenteral and Enteral Nutrition 1995;19:453‐60. - PubMed
Corcoy 1988
    1. Corcoy R, Ma Sanachez J, Domingo P, et al. Nutrition in patients with severe acute pancreatitis. Nutrition 1988;4:269‐75.
Eatock 2005
    1. Eatock FC, Chong P, Menezes N, Murray L, McKay CJ, Carter CR, Imrie CW. A randomized study of early nasogastric versus nasojejunal feeding in severe acute pancreatitis. American Journal of Gastroenterology 2005;100(2):432‐9. - PubMed
Fink 1991
    1. Fink MP. Gastrointestinal mucosal injury in experimental models of shock, trauma and sepsis. Critical Care Medicine 1991;19:627‐41. - PubMed
Gardiner 1995
    1. Gardiner KR, Kirk SJ, Rowlands BD. Novel substrates to maintain gut integrity. Nutrition Research Reviews 1995;8:43‐66. - PubMed
Goodgame 1977
    1. Goodgame JT, Fischer JE. Parenteral nutrition in the treatment of pancreatitis: effect on complications and mortality. Annals of Surgery 1977;186:651‐8. - PMC - PubMed
Grant 1984
    1. Grant JP, James S, Gratosowski V, Trexler KM. Total parenteral nutrition in pancreatic disease. Annals of Surgery 1984;200:627‐31. - PMC - PubMed
Hancke 1987
    1. Hancke E, Marlein G. Bacterial contamination of the pancreas with intestinal germs: A cause of acute suppurative pancreatitis. In: Berger HG editor(s). Acute Pancreatitis. Berlin: Spring‐Verlag, 1987:87‐9.
Havala 1989
    1. Havala T, Shronts E, Cerra F. Nutritinal support in acute pancreatitis. Gastroenterology Clinics of North America 1989;18:525‐42. - PubMed
Helton 1990
    1. Helton WS. Intravenous nutrition in patients with acute pancreatitis. In: Rombeau JL editor(s). Clinical nutrition: Parenteral nutrition. Philadelphia: WB Saunders, 1990:442‐61.
Higgins 2008
    1. Higgins JPT, Altman DG (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Greens S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Chichester (UK): John Wiley & sons, 2008.
Higgins 2008a
    1. Higgins JPT, Deeks JJ, Altman DG (editors). Chapter 16: Special topics in statistics. In: Higgins JPT, Green S (editors), Cochrane Handbook for Systematic Reviews of Interventions. Chichester (UK): John Wiley & Sons, 2008.
Jadad 1996
    1. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, McQuay H. Assessing the quality of reports of randomized clinical trials: Is blinding necessary?. Controlled Clinical Trials 1996;17:1‐12. - PubMed
Jüni 1999
    1. Jüni P, Witschi A, Bloch R, Egger M. The hazards of scoring the quality of clinical trials for meta‐analysis. JAMA 1999;282:1054‐1060. - PubMed
Kalfarentzos 1991
    1. Kalfarentzos FE, Karavias DD, Karatzas TM Alevizatos BA, Androulakis JA. Total parenteral nutrition in severe acute pancreatitis. Journal of the American College of Nutrition 1991;10:156‐62. - PubMed
Keys 1950
    1. Keys A, Brozek J, Henschel A. The biology of human starvation. Minneapolis: University of Minnesota Press, 1950.
Knaus 1985
    1. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE‐II: a severity of disease classification. Critical Care Medicine 1985;13:818‐29. - PubMed
Knaus 1991
    1. Knaus WA, Wagner DP, Draper EA, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized patients. Chest 1991;100:1619‐1636. - PubMed
Kumar 2006
    1. Kumar A, Singh N, Prakash S, Saraya A, Joshi YK. Early enteral nutrition in severe acute pancreatitis: a prospective randomized controlled trial comparing nasojejunal and nasogastric routes. Journal of Clinical Gastroenterology 2006;40(5):431‐4. - PubMed
Lange 1987
    1. Lange JF, Gool J, Tytgat GN. The protective effect of a reduction in intestinal flora on mortality of acute haemorrhagic pancreatitis in the rat. Hepatogastroenterology 1987;34:28‐30. - PubMed
Lefebvre 2008
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Wiley, 2008.
Marik 2004
    1. Marik PE, Zaloga GP. Meta‐analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis. BMJ 2004;328:1407. - PMC - PubMed
Maxton 1989
    1. Maxton DG, Menzies IS, Salvin B, Thompson RPH. Small intestinal function during enteral feeding and starvation in man. Clinical Science (Colch.) 1989;77:401‐6. - PubMed
McClave 1986
    1. McClave EE, Jones TN. Benefits of immediate jejunostomy feeding after major abdominal trauma ‐ a prospective randomized trial. Journal of Trauma 1986;26:874‐81. - PubMed
McClave 1998
    1. McClave SA, Snider H, Owens N, Sexton LK. Nutritional management in acute and chronic pancreatitis. Gastroenterology Clinics of North America 1998;27:421‐34. - PubMed
McClave 2006
    1. McClave SA, Chang WK, Dhaliwal R, Heyland DK. Nutrition support in acute pancreatitis: a systematic review of the literature. Journal of Parenteral and Enteral Nutrition 2006;30(2):143‐56. - PubMed
Moore 1992
    1. Moore FA, Feliciano DV, Andrassy RJ, McArdle AH, Booth FV, Morgenstein‐Wagner TB, Kellum JM Jr, Welling RE, Moore EE. Early enteral compared with parenteral nutrition reduces postoperative septic complications: the results of a meta‐analysis. Annals of Surgery 1992;216:172‐83. - PMC - PubMed
Pisters 1992
    1. Pisters PW, Ranson JHC. Nutritional support of acute pancreatitis. Surgery Gynecology & Obstetrics 1992;175:275‐84. - PubMed
Povoski 1995
    1. Povoski SP, Nussbaum MS. Nutrition support in pancreatitis: fertile ground for prospective clinical investigation. Nutrition in Clinical Practice 1995;10:43‐44. - PubMed
Runkel 1991
    1. Runkel NS, Moody FG, Smith GS, Rodriguez MT, LaRocco MT, Miller TA. The role of the gut in the development of sepsis in acute pancreatitis. Journal of Surgical Research 1991;51:18‐23. - PubMed
Russel 1983
    1. Russel JC, Welch JP, Clark DG. Colonic complications of acute pancreatitis and pancreatic abscess. American Journal of Surgery 1983;146:558‐64. - PubMed
Ryan 1993
    1. Ryan CM, Schmidt J, Lawandrowski K, Compton CC, Rattner DW, Warshaw AL, Tompkins RG. Gut macromolecular permeability in pancreatitis correlates with severity of disease in rats. Gastroenterology 1993;104:890‐5. - PubMed
Saadia 1990
    1. Saadia R, Schein M, MacFarlance C, Boffard KD. Gut barrier function and the surgeon. British Journal of Surgery 1990;77:487‐92. - PubMed
Schünemann 2008
    1. Schünemann HJ, Oxman AD, Higgins JPT, Vist GE, Glasziou P, Guyatt GH. Chapter 11: Presenting results and Summary of findings tables. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Chichester (UK): John Wiley & Sons, 2008.
Scolapio 1999
    1. Scolapio JS, Malhi‐Chowla N, Ukleja A. Nutrition supplementation in patients with acute and chronic pancreatitis. Gastroenterology Clinics of North America 1999;28:695‐707. - PubMed
Sitzmann 1989
    1. Sitzmann JV, Steinborn PA, Zinner MJ, Cameron JL. Total parenteral nutrition and alternate energy substrates in treatment of severe acute pancreatitis. Surgery Gynaecology & Obstetrics 1989;168:311‐17. - PubMed
Steinberg 1994
    1. Steinberg W, Tenner S. Acute pancreatitis. New England Journal of Medicine 1994;330:1198‐210. - PubMed
Sterne 2008
    1. Sterne JAC, Egger M, Moher D (editors). Chapter 10: Addressing reporting biases. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Chichester (UK): John Wiley & Sons, 2008.
Twomey 1985
    1. Twomey P, Patching S. Cost‐effectiveness of nutritional support. Journal of Parenteral and Enteral Nutrition 1985;9:3‐7. - PubMed
VanGossum 1988
    1. VanGossum A, Lemoyne M, Greig PD, Jeejeebhoy KN. Lipid associated total parenteral nutrition in patients with severe acute pancreatitis. Journal of Parenteral and Enteral Nutrition 1988;12:250‐5. - PubMed