PhD Scientific Days 2023

Clinical Medicine V.

Early versus Delayed Enteral Nutrition in Patients after Gastrointestinal Bleeding: Meta-analysis of Randomized Controlled Trials

Text of the abstract

INTRODUCTION
Despite lack of evidence, patients are kept nil by mouth for 48 to 96 hours after upper gastrointestinal bleeding (UGIB) due to fear of rebleeding. However, many trials have demonstrated the benefits of early enteral nutrition (EEN) after UGIB.

AIMS
We conducted a meta-analysis of randomized controlled trials to evaluate the safety and outcomes of EEN compared to delayed enteral nutrition (DEN) after UGIB.

METHODS
The protocol was registered on PROSPERO in advance (CRD42022372306). Five databases (PubMed, Embase, CENTRAL, Scopus, and Web of Science) were searched on the 10th of November 2022 to identify randomized controlled trials that met our eligibility criteria. In-hospital and 30-day outcomes were pooled separately. Mortality rate, rebleeding rate, and length of hospital stay were the primary outcomes. The pooled risk ratio (RR), mean difference (MD), and the corresponding 95% confidence interval (CI) were calculated using a random-effects model.

RESULTS
A total of 10 trials with 1,051 patients were included in the analysis. Compared with DEN, there was a clear tendency for a decrease in 30-day mortality in the EEN group (RR=0.57, CI: 0.31 – 1.04), while 7-day mortality showed a more similar result (RR=1.23, CI: 0.72 - 2.10). As for 7-day and 30-day rebleeding, there was no statistically significant difference between the two groups (RR=1.05, CI: 0.63 – 1.74 and RR=1.16, CI: 0.59 – 2.26, respectively). In addition, our analysis showed that the EEN group needed a reduced length of hospital stay compared to the DEN group (MD= - 1.22, CI: -2.43 to -0.01).

CONCLUSION
Compared with DEN, EEN appears to be a safe intervention and could reduce the length of hospital stay without increasing the risk of complications regarding rebleeding or mortality after upper gastrointestinal bleeding.