Parenteral versus enteral nutrition for the conservative treatment of postoperative pancreatic fistula following pancreatic surgery: A systematic review and meta-analysis
Bibliographic record
Abstract
Background: Approximately 10%-40% of patients undergoing pancreatic surgery develop postoperative pancreatic fistula (POPF)1-4. Currently, conservative management focusing on nutritional optimization is widely applied in the setting of POPF. However, there is no consensus on the most effective route for administration of nutrients in this setting5-7. We aimed to compare the efficacy of parenteral nutrition (control) versus enteral nutrition (intervention) in the rate of POPF closure. Materials and Methods: Medline, EMBASE, CENTRAL, and Web of Science databases were searched for randomized controlled trials comparing enteral to parenteral nutrition in the conservative management of POPF and reported time to POPF closure. Quality was assessed using the Cochrane Risk of Bias Tool and quality of pooled evidence was assessed using the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation)8-9. Results: From 2,682 relevant citations, three studies including a total of 167 patients were analyzed (85 patients in the enteral group and 82 patients in the parenteral group). The mean time to POPF closure was 3.46 days shorter in the enteral group (intervention) than the parenteral group (control), which failed to reach statistical significance (95% CI -3.22 to 10.49, P = 0.30, I2=39%). The complication rates in both groups were low and there were no significant differences in overall complication rate (OR 1.69, 95% CI 0.52 to 5.47, P = 0.38) or hospital length of stay in days (MD 0.76, 95% CI -9.21 to 10.74, P = 0.88). Conclusions: The rate of POPF closure is equivalent in patients receiving enteral feeds compared to those receiving parenteral feeds. The choice between enteral and parenteral feeds in the conservative management of POPF should be largely determined by individual patient factors.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.023 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.028 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".