Análisis crítico de un artículo

Objective: To compare the safety and clinical outcomes of enteral and parenteral nutrition in patients with acute pancreatitis. Data sources: Medline, Embase, Cochrane controlled trials register, and citation review of relevant primary and review articles. Study selection: Randomized controlled studies that compared enteral nutrition with parenteral nutrition in patients with acute pancreatitis. From 117 articles screened, six were identified as randomized controlled trials and were included for data extraction. Data extraction: Six studies with 263 participants were analyzed. Descriptive and outcome data were extracted. Main outcome measures were infections, complications other than infections, operative interventions, length of hospital stay, and mortality. The metaanalysis was performed with the random effects model. Data synthesis: Enteral nutrition was associated with a significantly lower incidence of infections (relative risk 0.45; 95% confidence interval 0.26 to 0.78, P= 0.004), reduced surgical interventions to control pancreatitis (0.48, 0.22 to 1.0, P= 0.05), and a reduced length of hospital stay (mean reduction 2.9 days, 1.6 days to 4.3 days, P <0.001). There were no significant differences in mortality (relative risk 0.66, 0.32 to 1.37, P = 0.3) or non-infectious complications (0.61, 0.31 to 1.22, P= 0.16) between the two groups of patients. Conclusions: Enteral nutrition should be the preferred route of nutritional support in patients with acute pancreatitis.

Análisis crítico de un artículo / Critical appraisal: Band ligation and propranolol are equally effective for primary prevention of variceal bleeding

In this randomized controlled multicenter trial, we compared endoscopic variceal banding ligation (VBL) with propranolol (PPL) for primary prophylaxis of variceal bleeding. One hundred fifty-two cirrhotic patients with 2 or more esophageal varices (diameter >5 mm) without prior bleeding were randomized to VBL (n=75) or PPL (n=77). The groups were well matched with respect to baseline characteristics (age 56±10 years, alcoholic etiology 51%, Child-Pugh score 7.2±1.8). The mean follow-up was 34±19 months. Data were analyzed on an intention-to-treat basis. Neither bleeding incidence nor mortality differed significantly between the 2 groups. Variceal bleeding occurred in 25% of the VBL group and in 29% of the PPL group. The actuarial risks of bleeding after 2 years were 20% (VBL) and 18% (PPL). Fatal bleeding was observed in 12% (VBL) and 10% (PPL). It was associated with the ligation procedure in 2 patients (2.6%). Overall mortality was 45% (VBL) and 43% (PPL) with the 2-year actuarial risks being 28% (VBL) and 22% (PPL). 25% of patients withdrew from PPL treatment, 16% due to side effects. In conclusion, VBL and PPL were similarly effective for primary prophylaxis of variceal bleeding. VBL should be offered to patients who are not candidates for long-term PPL treatment.