Early enteral nutrition is superior to delayed enteral nutrition for the prevention of infected necrosis and mortality in acute pancreatitis

Pancreas. 2013 May;42(4):640-6. doi: 10.1097/MPA.0b013e318271bb61.


Objectives: The exact time of initiation of total enteral nutrition (TEN) in severe acute pancreatitis (SAP) and its influence on the disease outcome are not well known.

Methods: An analysis of 197 cases with predicted SAP allocated to: group A (n = 97), early TEN (started within the first 48 hours after admission to hospital); and group B (n = 100), delayed TEN (started after 48 hours).

Results: Infection of necrosis/fluid collections occurred in 4 patients in group A and 18 patients in group B (P < 0.05). Respiratory failure and transfer to intensive care unit occurred more frequently in group B than in group A (15 vs 5 and 15 vs 3 patients; P < 0.05). Multiple-organ failure was observed in 9 patients in group A and 16 patients in group B (P > 0.05). Seven patients in group A and 11 patients in group B underwent surgery (P > 0.05). All 9 reported deaths occurred in group B (P < 0.05). The time to start TEN was a predictor of infected necrosis/fluid collection (odds ratio, 4.09; P = 0.028).

Conclusions: Delayed compared to early TEN is associated with higher mortality, increased frequency of infected necrosis/fluid collections, respiratory failure, and a need for intensive care unit hospitalization. Enteral nutrition in SAP should be started within 48 hours after admission to hospital.

MeSH terms

  • Adult
  • Enteral Nutrition / methods*
  • Female
  • Humans
  • Lung Diseases / etiology
  • Male
  • Middle Aged
  • Pancreatitis / complications
  • Pancreatitis / mortality
  • Pancreatitis / therapy*
  • Pancreatitis, Acute Necrotizing / microbiology
  • Pancreatitis, Acute Necrotizing / prevention & control
  • Prognosis
  • Retrospective Studies
  • Time Factors