Gut or Vein? Enteral Nutrition Versus Total Parenteral Nutrition in Acute Pancreatitis: A Systematic Review

Acute pancreatitis is a common inflammatory condition with significant morbidity and mortality, particularly in patients who progress to moderately severe or severe disease. Nutritional support is an essential aspect of management, although the optimal route of nutrition remains debated. This systematic review assessed whether enteral nutrition (EN), compared with total parenteral nutrition (TPN), is associated with improved clinical outcomes in patients with acute pancreatitis. A thorough literature search was conducted across multiple electronic databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, including studies published between 1/01/2010 and 22/11/2025. A total of 1,480 records were identified, of which 1,382 records were screened after duplicate removal. Following title, abstract, and full text assessment, six studies met the predefined inclusion criteria and quality standards and were included in the final analysis. Eligible studies included human patients with acute pancreatitis that directly compared EN with TPN and reported clinically relevant outcomes such as morbidity and mortality. Study selection, data extraction, and quality appraisal were conducted using validated tools, including version 2 of A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) and the Newcastle-Ottawa scale. Across the included studies, EN was consistently associated with reduced mortality, fewer infectious complications, lower rates of multiple organ failure, and a reduced need for surgical intervention compared with TPN. Several studies also reported shorter hospital stays, although this finding was not uniform across all studies. Overall, the available evidence supports EN as the preferred nutritional strategy in acute pancreatitis, showing favorable effects on key clinical outcomes when compared with TPN. However, heterogeneity among studies remains high, highlighting the need for further research within contemporary clinical practice.