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Outcomes of Early Enteral Feeding (<48 Hours) in Patients With Predicted Severe Acute Pancreatitis
Arjun Chatterjee1, Zehra Naseem2, Ridhima Kaul2
1Departments of Gastroenterology, Hepatology, and Nutrition.
Insights
Early enteral nutrition (EEN) within 48 hours significantly improves outcomes for severe acute pancreatitis (SAP) patients. This approach reduces ICU stays, complications, and costs, supporting its role as a clinical standard.
Area of Science:
- Gastroenterology
- Critical Care Medicine
- Surgical Nutrition
Background:
- Early enteral nutrition (EEN) is recommended for severe acute pancreatitis (SAP).
- Optimal timing for initiating EEN in predicted SAP patients remains debated.
- Clinical outcomes of initiating EEN within 48 hours versus later are unclear.
Purpose of the Study:
- To compare outcomes in predicted SAP patients receiving EEN within 48 hours versus later.
- To evaluate the impact of early EEN on patient recovery and resource utilization.
Main Methods:
- Retrospective cohort study of 83 adult predicted SAP patients (BISAP score ≥2).
- EEN defined as initiation within 48 hours of diagnosis; late feeding initiated >48 hours.
- Exclusion criteria included chronic pancreatitis, TPN-only treatment, and missing data.
Main Results:
- Patients receiving EEN within 48 hours had significantly shorter ICU stays (14.7 vs. 25.4 days).
- Early EEN was associated with fewer pancreatic fluid collections (22.2% vs. 48.2%) and gastrointestinal complications (48.1% vs. 75%).
- Improved composite outcomes included decreased mortality, ICU needs, and lower hospital costs.
Conclusions:
- Initiating EEN within 48 hours significantly improves outcomes in predicted SAP patients.
- Early EEN supports its establishment as a clinical standard for SAP management.
- Further prospective studies are warranted to confirm these benefits.
Background:
Early enteral nutrition (EEN) is preferred for severe acute pancreatitis (SAP) patients, but the optimal timing is controversial. The clinical implications of initiating EEN within 48 hours versus later (>48 h) in predicted SAP patients are unclear. This study compares outcomes in predicted SAP patients receiving EEN within 48 hours to those receiving it later.
Methods:
Retrospective cohort study of adults (18 years or older) with predicted SAP (BISAP score ≥2) from May 2011 to July 2023. EEN was defined as initiation within 48 hours of diagnosis. Exclusions included inaccurate diagnoses, outside transfers, missing data, chronic pancreatitis, acute exacerbations of chronic pancreatitis, and TPN-only treatment. Statistical analysis included χ 2 , Fisher exact tests, and 2-sample t -tests.
Results:
Among 83 predicted SAP patients, 27 received EEN within 48 hours, and 56 received late feeding. Baseline characteristics, including age, gender, BMI, and BISAP score, were similar. Postpyloric feeding was used in 91.6%, and 45.6% reached goal feeding rates in <72 hours. The EEN group had statistically significant shorter ICU stays (14.7 vs. 25.4 d, P =0.011), fewer pancreatic fluid collections (22.2% vs. 48.2%, P =0.043), and fewer gastrointestinal complications (48.1% vs. 75%, P =0.03). Early EEN (<48 h) showed improved composite outcomes, including decreased mortality, ICU needs, early systemic complications, and lower hospital and ICU costs.
Conclusion:
This novel study demonstrated that initiating EEN within 48 hours in predicted SAP patients significantly improves outcomes, highlighting its importance in management. These findings support EEN as a clinical standard for SAP patients and call for future prospective studies to confirm its benefits.
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