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Meta-Analysis
. 2020 Mar 26;3(3):CD010582.
doi: 10.1002/14651858.CD010582.pub2.

Nasogastric versus nasojejunal tube feeding for severe acute pancreatitis

Amit Kumar Dutta  1 , Ashish Goel  2 , Richard Kirubakaran  3 , Ashok Chacko  1 , Prathap Tharyan  4
Affiliations
Meta-Analysis

Nasogastric versus nasojejunal tube feeding for severe acute pancreatitis

Amit Kumar Dutta et al. Cochrane Database Syst Rev. .

Abstract

Background: Nutrition is an important aspect of management in severe acute pancreatitis. Enteral nutrition has advantages over parenteral nutrition and is the preferred method of feeding. Enteral feeding via nasojejunal tube is often recommended, but its benefits over nasogastric feeding are unclear. The placement of a nasogastric tube is technically simpler than the placement of a nasojejunal tube.

Objectives: To compare the mortality, morbidity, and nutritional status outcomes of people with severe acute pancreatitis fed via nasogastric tube versus nasojejunal tube.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and LILACS on 17 October 2019 without using any language restrictions. We also searched reference lists and conference proceedings for relevant studies and clinical trial registries for ongoing trials. We contacted authors for additional information.

Selection criteria: We included randomised controlled trials (RCTs) and quasi-RCTs comparing enteral feeding by nasogastric and nasojejunal tubes in participants with severe acute pancreatitis.

Data collection and analysis: Two review authors independently screened studies for inclusion, assessed risk of bias of the included studies, and extracted data. This information was independently verified by the other review authors. We used standard methods expected by Cochrane to assess the risk of bias and perform data synthesis. We rated the certainty of evidence according to GRADE.

Main results: We included five RCTs that randomised a total of 220 adult participants from India, Scotland, and the USA. Two of the trial reports were available only as abstracts. The trials differed in the criteria used to rate the severity of acute pancreatitis, and three trials excluded those who presented in severe shock. The duration of onset of symptoms before presentation in the trials ranged from within one week to four weeks. The trials also differed in the methods used to confirm the placement of the tubes and in what was considered to be nasojejunal placement. We assessed none of the trials as at high risk of bias, though reporting of methods in four trials was insufficient to judge the risk of bias for one or more of the domains assessed. There was no evdence of effect with nasogastric or nasojejunal placement on the primary outcome of mortality (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.36 to 1.17; I2 = 0%; 5 trials, 220 participants; very low-certainty evidence due to indirectness and imprecision). Similarly, there was no evidence of effect on the secondary outcomes for which data were available. These included organ failure (3 trials, 145 participants), rate of infection (2 trials, 108 participants), success rate (3 trials, 159 participants), complications associated with the procedure (2 trials, 80 participants), need for surgical intervention (3 trials, 145 participants), requirement of parenteral nutrition (2 trials, 80 participants), complications associated with feeds (4 trials, 195 participants), and exacerbation of pain (4 trials, 195 participants). However, the certainty of the evidence for these secondary outcomes was also very low due to indirectness and imprecision. Three trials (117 participants) reported on length of hospital stay, but the data were not suitable for meta-analysis. None of the trials reported data suitable for meta-analysis for the other secondary outcomes of this review, which included days taken to achieve full nutrition requirement, duration of tube feeding, and duration of analgesic requirement after feeding tube placement.

Authors' conclusions: There is insufficient evidence to conclude that there is superiority, inferiority, or equivalence between the nasogastric and nasojejunal mode of enteral tube feeding in people with severe acute pancreatitis.

PubMed Disclaimer

Conflict of interest statement

AKD: none known.

AG: none known.

RK: none known.

AC: none known.

PT: none known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 Nasogastric versus nasojejunal tube feeding, outcome: 1.1 Mortality.
5
5
Forest plot of comparison: 1 Nasogastric versus nasojejunal tube feeding, outcome: 1.2 Organ failure (single or multiple).
6
6
Forest plot of comparison: 1 Nasogastric versus nasojejunal tube feeding, outcome: 1.4 Success rate of the procedure.
1.1
1.1. Analysis
Comparison 1 Nasogastric versus nasojejunal tube feeding, Outcome 1 Mortality.
1.2
1.2. Analysis
Comparison 1 Nasogastric versus nasojejunal tube feeding, Outcome 2 Organ failure (single or multiple).
1.3
1.3. Analysis
Comparison 1 Nasogastric versus nasojejunal tube feeding, Outcome 3 Rate of infection (local or systemic).
1.4
1.4. Analysis
Comparison 1 Nasogastric versus nasojejunal tube feeding, Outcome 4 Success rate of the procedure.
1.5
1.5. Analysis
Comparison 1 Nasogastric versus nasojejunal tube feeding, Outcome 5 Complications associated with the procedure.
1.6
1.6. Analysis
Comparison 1 Nasogastric versus nasojejunal tube feeding, Outcome 6 Surgical intervention.
1.7
1.7. Analysis
Comparison 1 Nasogastric versus nasojejunal tube feeding, Outcome 7 Requirement for parenteral nutrition.
1.8
1.8. Analysis
Comparison 1 Nasogastric versus nasojejunal tube feeding, Outcome 8 Complications associated with the feeds.
1.9
1.9. Analysis
Comparison 1 Nasogastric versus nasojejunal tube feeding, Outcome 9 Exacerbation of pain.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD010582

References

References to studies included in this review

Eatock 2005 {published data only}
    1. Eatock FC, Chong P, Menezes N, Murray L, McKay CJ, Carter CR, et al. A randomized study of early nasogastric versus nasojejunal feeding in severe acute pancreatitis. American Journal of Gastroenterology 2005;100(2):432‐9. [PUBMED: 15667504] - PubMed
Kumar 2006 {published data only}
    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: 16721226] - PubMed
Moparty 2015 {published data only (unpublished sought but not used)}
    1. Moparty E, Kumar PS, Umadevi M, Ramanna M. A comparison of nasogastric and nasojejunal feeding in the enteral nutrition of acute pancreatitis. Indian Journal of Gastroenterology 2015;34(Suppl 1):A79.
O'Keefe 2014 {published data only (unpublished sought but not used)}
    1. NCT00580749. Study of Nutrition in Acute Pancreatitis SNAP. clinicaltrials.gov/ct2/show/NCT00580749 (first received 27 December 2007).
    1. O'Keefe SJ, Whitcomb DC, Cote GA. Study of Nutrition in Acute Pancreatitis (SNAP): a randomized, multicenter, clinical trial of nasogastric vs. distal jejunal feeding. Gastroenterology (Conference publications) 2014;146(5 Suppl 1):S800. [NCT00580749]
Singh 2012 {published data only}
    1. CTRI/2009/091/000948. A clinical trial to study the route of enteral feeding (nasogastric versus nasojejunal) in acute pancreatitis [Role of enteral nutrition in preventing complications in severe acute pancreatitis in randomised control trial]. ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=1096&EncHid=&us... (first received 1/12/2009).
    1. Singh N, Sharma B, Sharma M, Sachdev V, Bhardwaj P, Mani K, et al. Evaluation of early enteral feeding through nasogastric and nasojejunal tube in severe acute pancreatitis: a non‐inferiority randomized controlled trial. Pancreas 2012;41(1):153‐9. [PUBMED: 21775915] - PubMed

References to studies excluded from this review

Lou 2016 {published data only (unpublished sought but not used)}
    1. Lou J, Zhao H, Yu J, Luo Y, Chen F, Chen J. Nasogastric or nasojejunal tube feeding in pediatric acute pancreatitis: a clinical, randomized pilot study. Journal of Pediatric Gastroenterology and Nutrition 2016; Vol. 62:48. [DOI: 10.1097/01.mpg.0000484500.48517.e7; CN‐01167833] - DOI
Piciucchi 2010 {published data only}
    1. Piciucchi M, Merola E, Marignani M, Signoretti M, Valente R, Cocomello L, et al. Nasogastric or nasointestinal feeding in severe acute pancreatitis. World Journal of Gastroenterology 2010;16(29):3692‐6. [PUBMED: 20677342] - PMC - PubMed

References to studies awaiting assessment

Du 2015 {published data only (unpublished sought but not used)}
    1. Du ZH, Wang WQ, Chen L, Luo J, Zhou LF, Zhou XQ. The application of enteral nutrition by nasogastric tube in severe acute pancreatitis. Parenteral & Enteral Nutrition 2015;22:168‐70.
Jiang 2011 {published data only (unpublished sought but not used)}
    1. Jiang RL, Ma WB, Lei L, Wang LC, Wu JN, Zhu MF, et al. Influence of different enteral feeding route through nose on course of diseases in severe acute pancreatitis. Parenteral & Enteral Nutrition 2011;18:82‐4.
Luo 2015 {published data only (unpublished sought but not used)}
    1. Luo XJ. The clinic effects of early nasogastric enteral nutrition on severe acute pancreatitis. Sichuan: Sichuan Medical College 2015:1‐46.
Ouyang 2011 {published data only (unpublished sought but not used)}
    1. Ouyang YX. Two feeding methods used for enteral nutrition in patients with severe acute pancreatitis. Contemporary Nurse 2011;3:103‐4.
Xiaoli 2011 {published data only (unpublished sought but not used)}
    1. Xiaoli LY, Dong LH, Xu WB. Two ways of enteral nutrition for the treatment of severe acute pancreatitis: a clinical research. Yunnan Medicine 2011;32:312‐4.

Additional references

Al‐Omran 2010
    1. Al‐Omran M, Albalawi ZH, Tashkandi MF, Al‐Ansary LA. Enteral versus parenteral nutrition for acute pancreatitis. Cochrane Database of Systematic Reviews 2010, Issue 1. [DOI: 10.1002/14651858.CD002837.pub2] - DOI - PMC - PubMed
Balthazar 1990
    1. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology 1990;174(2):331‐6. [DOI: 10.1148/radiology.174.2.2296641] - DOI - PubMed
Balthazar 1994
    1. Balthazar EJ, Freeny PC, Sonnenberg E. Imaging and intervention in acute pancreatitis. Radiology 1994;193(2):297‐306. [DOI: 10.1148/radiology.193.2.7972730] - DOI - PubMed
Banks 2002
    1. Banks PA. Epidemiology, natural history, and predictors of disease outcome in acute and chronic pancreatitis. Gastrointestinal Endoscopy 2002;56(Suppl):S226‐30. [DOI: 10.1067/mge.2002.129022] - DOI - PubMed
Banks 2006
    1. Banks PA, Freeman ML, Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. American Journal of Gastroenterology 2006;101(10):2379‐400. [DOI: 10.1111/j.1572-0241.2006.00856.x] - DOI - PubMed
Banks 2012
    1. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Saar MG, et al. Classification of acute pancreatitis ‐ 2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102‐11. [DOI: 10.1136/gutjnl-2012-302779] - DOI - PubMed
Blamey 1984
    1. Blamey SL, Imrie CW, O'Neill J, Gilmour WH, Carter DC. Prognostic factors in acute pancreatitis. Gut 1984;25(12):1340‐6. [DOI: 10.1136/gut.25.12.1340] - DOI - PMC - PubMed
Bollen 2016
    1. Bollen TL. Acute pancreatitis: international classification and nomenclature. Clinical Radiology 2016;71(2):121‐33. [DOI: 10.1016/j.crad.2015.09.013.] - DOI - PubMed
Bradley 1993
    1. Bradley EL 3rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Archives of Surgery 1993;128:586‐90. - PubMed
Buter 2002
    1. Buter A, Imrie CW, Carter CR, Evans S, McKay CJ. Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis. British Journal of Surgery 2002;89(3):298‐302. [DOI: 10.1046/j.0007-1323.2001.02025.x] - DOI - PubMed
Büchler 1986
    1. Büchler M, Malfertheiner P, Schoetensack C, Uhl W, Scherbaum W, Beger HG. Value of biochemical and imaging procedures for the diagnosis of acute pancreatitis ‐ results of a prospective clinical study. Zeitschrift fur Gastroenterologie 1986;24(2):100‐9. [PUBMED: 2421494] - PubMed
Cao 2008
    1. Cao Y, Xu Y, Lu T, Gao F, Mo Z. Meta‐analysis of enteral nutrition versus total parenteral nutrition in patients with severe acute pancreatitis. Annals of Nutrition & Metabolism 2008;53(3‐4):268‐75. [DOI: 10.1159/000189382] - DOI - PubMed
Chan 2013
    1. Chan A‐W, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža‐Jerić K, et al. SPIRIT 2013 Statement: Defining standard protocol items for clinical trials. Annals of Internal Medicine 2013;158:200‐7. [DOI: 10.7326/0003-4819-158-3-201302050-00583] - DOI - PMC - PubMed
Chang 2013
    1. Chang YS, Fu HQ, Xiao YM, Liu JC. Nasogastric or nasojejunal feeding in predicted severe acute pancreatitis: a meta‐analysis. Critical Care 2013;17(3):R118. - PMC - PubMed
Cresci 2003
    1. Cresci G, Martindale R. Bedside placement of small bowel feeding tubes in hospitalized patients: a new role for the dietitian. Nutrition 2003;19(10):843‐6. [PUBMED: 14559318] - PubMed
Dellinger 2012
    1. Dellinger EP, Forsmark CE, Layer P, Lévy P, Maraví‐Poma E, Petrov MS, et al. Determinant‐based classification of acute pancreatitis severity: an international multidisciplinary consultation. Annals of Surgery 2012;256(6):875‐80. [DOI: 10.1097/SLA.0b013e318256f778] - DOI - PubMed
Eatock 2000
    1. Eatock FC, Brombacher GD, Steven A, Imrie CW, McKay CJ, Carter R. Nasogastric feeding in severe acute pancreatitis may be practical and safe. International Journal of Pancreatology 2000;28(1):23‐9. - PubMed
Feng 2013
    1. Feng S‐F, Tang S‐H, Zhang X‐J. Tolerence and efficacy of nasogastric enteral nutrition for severe acute pancreatitis: a meta‐analysis. Medical Journal of Chinese People's Liberation Army 2013;38(2):141‐6.
Greenberg 2016
    1. Greenberg JA, Hsu J, Bawazeer M, Marshall J, Friedrich JO, Nathens A, et al. Clinical practice guideline: management of acute pancreatitis. Canadian Journal of Surgery 2016;59(2):128‐40. [PUBMED: 27007094 ] - PMC - PubMed
Guo 2016
    1. Guo Y‐J, Jing X, Tian Z‐B. Comparison of nasogastric feeding versus nasojejunal feeding for severe acute pancreatitis: a systematic review and meta‐analysis. International Journal of Clinical and Experimental Medicine 2016;9(11):22814‐23.
Herbison 2012
    1. Herbison P. What should be done with quasi‐randomised trials?. editorial‐unit.cochrane.org/blog/guest‐blog‐peter‐herbison‐what‐should‐be‐done‐qua... (accessed 10 August 2016).
Higgins 2002
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Statistics in Medicine 2002;21(11):1539‐58. [PUBMED: 12111919] - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. [PUBMED: 12958120] - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
IAP/APA Acute Pancreatitis Guidelines 2013
    1. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence‐based guidelines for the management of acute pancreatitis. Pancreatology 2013;13(4 Suppl 2):e1‐15. [DOI: 10.1016/j.pan.2013.07.063] - DOI - PubMed
Ioannidis 2008
    1. Ioannidis O, Lavrentieva A, Botsios D. Nutrition support in acute pancreatitis. Journal of the Pancreas 2008;9(4):375‐90. - PubMed
Jiang 2007
    1. Jiang K, Chen XZ, Xia Q, Tang WF, Wang L. Early nasogastric enteral nutrition for severe acute pancreatitis: a systematic review. World Journal of Gastroenterology 2007;13(39):5253‐60. - PMC - PubMed
Knaus 1985
    1. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Critical Care Medicine 1985;13(10):818‐29. - PubMed
Li 2013
    1. Li J‐Y, Yu T, Chen G‐C, Yuan Y‐H, Zhong W, Zhao L‐N, et al. Enteral nutrition within 48 hours of admission improves clinical outcomes of acute pancreatitis by reducing complications: a meta‐analysis. PLoS ONE 2013;8(6):e64926. [DOI: 10.1371/journal.pone.0064926] - DOI - PMC - PubMed
Marshall 1995
    1. Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Critical Care Medicine 1995;23:1638‐52. - PubMed
Mofidi 2006
    1. Mofidi R, Duff MD, Wigmore SJ, Madhavan KK, Garden OJ, Parks RW. Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. British Journal of Surgery 2006;93(6):738‐44. [DOI: 10.1002/bjs.5290] - DOI - PubMed
Nally 2014
    1. Nally DM, Kelly EG, Clarke M, Ridgway P. Nasogastric nutrition is efficacious in severe acute pancreatitis: a systematic review and meta‐analysis. British Journal of Nutrition 2014;112(11):1769‐78. - PubMed
Ouzzani 2016
    1. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan‐a web and mobile app for systematic reviews. Systematic reviews 2016;5(1):210. [PUBMED: 27919275] - PMC - PubMed
Petrov 2008
    1. Petrov MS, Correia MI, Windsor JA. Nasogastric tube feeding in predicted severe acute pancreatitis: a systematic review of the literature to determine safety and tolerance. Journal of the Pancreas 2008;9(4):440‐8. - PubMed
Petrov 2009a
    1. Petrov MS, Pylypchuk RD, Uchugina AF. A systematic review on the timing of artificial nutrition in acute pancreatitis. British Journal of Nutrition 2009;101(6):787‐93. [DOI: 10.1017/S0007114508123443] - DOI - PubMed
Petrov 2009b
    1. Petrov MS, Loveday BP, Pylypchuk RD, McIlroy K, Phillips AR, Windsor JA. Systematic review and meta‐analysis of enteral nutrition formulations in acute pancreatitis. British Journal of Surgery 2009;96(11):1243‐52. - PubMed
Poropat 2015
    1. Poropat G, Giljaca V, Hauser G, Štimac D. Enteral nutrition formulations for acute pancreatitis. Cochrane Database of Systematic Reviews 2015, Issue 3. [DOI: 10.1002/14651858.CD010605.pub2] - DOI - PMC - PubMed
Ranson 1974
    1. Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Localio SA. Objective early identification of severe acute pancreatitis. American Journal of Gastroenterology 1974;61(6):443‐51. - PubMed
Review Manager 2014 [Computer program]
    1. The Nordic Cochrane Centre,The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre,The Cochrane Collaboration, 2014.
Schulz 2010
    1. Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMJ 2010;340:c332. [DOI: 10.1136/bmj.c332.] - DOI - PMC - PubMed
Spanier 2008
    1. Spanier BW, Dijkgraaf MG, Bruno MJ. Epidemiology, aetiology and outcome of acute and chronic pancreatitis: an update. Best Practice and Research. Clinical Gastroenterology 2008;22(1):45‐63. [PUBMED: 18206812] - PubMed
Tiengou 2006
    1. Tiengou L, Gloro R, Pouzoulet J, Bouhier K, Read M, Arnaud‐Battandier F, et al. Semi‐elemental formula or polymeric formula: is there a better choice for enteral nutrition in acute pancreatitis? Randomized comparative study. Journal of Parenteral and Enteral Nutrition 2006;30(1):1‐5. [DOI: 10.1177/014860710603000101] - DOI - PubMed
UK 2005
    1. UK Working Party on Acute Pancreatitis. UK guidelines for the management of acute pancreatitis. Gut 2005;54(Suppl 3):iii1‐9. - PMC - PubMed
Yadav 2013
    1. Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology 2013;144:1252e61. - PMC - PubMed
Yi 2012
    1. Yi F, Ge L, Zhao J, Lei Y, Zhou F, Chen Z, et al. Meta‐analysis: total parenteral nutrition versus total enteral nutrition in predicted severe acute pancreatitis. Internal Medicine 2012;51(6):523‐30. [PUBMED: 22449657] - PubMed
Zhao 2003
    1. Zhao G, Wang CY, Wang F, Xiong JX. Clinical study on nutrition support in patients with severe acute pancreatitis. World Journal of Gastroenterology 2003;9(9):2105‐8. - PMC - PubMed
Zhu 2016
    1. Zhu Y, Yin H, Zhang R, Ye X, We J. Nasogastric nutrition versus nasojejunal nutrition in patients with severe acute pancreatitis: a meta‐analysis of randomized controlled trials. Gastroenterology Research and Practice 2016;2016:Article ID 6430632. [DOI: 10.1155/2016/6430632] - DOI - PMC - PubMed

References to other published versions of this review

Dutta 2013
    1. Dutta AK, Goel A, Kirubakaran R, Chacko A. Nasogastric versus nasojejunal tube feeding for severe acute pancreatitis. Cochrane Database of Systematic Reviews 2013, Issue 6. [DOI: 10.1002/14651858.CD010582] - DOI - PMC - PubMed

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