Enteral Versus Parenteral Nutrition for Postoperative Pancreatic Fistula: A Systematic Review and Meta-analysis
Bibliographic record
Abstract
Background: Postoperative pancreatic fistula (POPF) remains a significant source of morbidity following pancreatic surgery.The most effective feeding route for the conservative management of POPF is currently unknown.We aimed to compare the efficacy of enteral to parenteral nutrition in the rate of POPF closure.Methods: Medline, EMBASE, CENTRAL, and Web of Science were searched for randomized controlled trials (RCTs) comparing enteral to parenteral nutrition in the conservative management of POPF.Risk of bias was assessed using the Cochrane Risk of Bias Tool.Quality of the evidence was assessed using GRADE.Random-effects meta-analysis was used to estimate time to POPF closure.Results: From 2,682 citations, three RCTs (n=167) were included (enteral group, n=85; parenteral group, n=82).Mean time to POPF closure was 3.64 days shorter in the enteral than the parenteral group, which was not statistically significant (95% CI -3.22 to 10.49, P = 0.30).There were no significant differences in postoperative complication rate (OR 1.69, 95% CI 0.52 to 5.47, P = 0.38) or length of hospital stay between groups (mean difference: 0.76, 95% CI -9.21 to 10.74, P = 0.88).According to GRADE, the overall certainty of the evidence for the main outcome was very low.Conclusions: There was no data to suggest that enteral nutrition is more effective than parenteral nutrition at enhancing the rate of POPF closure.However, the quality of evidence that currently exists is very low.Therefore, the decision between enteral and parenteral nutrition in this setting should still be based on physician preference and patient specific 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) | 0.019 | 0.031 |
| 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 | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 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".