Enhanced Recovery in Mild Acute Pancreatitis: A Randomized Controlled Trial

Pancreas. 2019 Feb;48(2):176-181. doi: 10.1097/MPA.0000000000001225.

Abstract

Objectives: Acute pancreatitis (AP) is a leading cause of hospitalization for a gastrointestinal illness in the United States. We hypothesized that enhanced recovery approaches may lead to earlier time to refeeding in patients with AP.

Methods: We performed a double-blind, randomized controlled trial of patients admitted with mild AP from July 2016 to April 2017 at a tertiary medical center. Participants were randomly assigned to receive either enhanced recovery consisting of nonopioid analgesia, patient-directed oral intake, and early ambulation versus standard treatment with opioid analgesia and physician-directed diet. Primary study end point was time to oral refeeding on an intent-to-treat basis. Secondary end points included differences in pancreatitis activity scores, morphine equivalents, length of stay, and 30-day readmissions.

Results: Forty-six participants enrolled. Median age was 53.1 years, and 54.3% were female. There was significant reduction in time to successful oral refeeding in the enhanced recovery versus standard treatment group (median, 13.8 vs 124.8 hours, P < 0.001). Pancreatitis activity scores trended lower at 48 to 96 hours among patients assigned to enhanced recovery (mean, 43.6 vs. 58.9, P = 0.32). No differences found in length of stay or 30-day readmissions.

Conclusion: In this randomized controlled trial, enhanced recovery was safe and effective in promoting earlier time to refeeding in patients hospitalized with AP.

Trial registration: ClinicalTrials.gov NCT02813876.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Analgesics / adverse effects
  • Analgesics / therapeutic use*
  • Analgesics, Opioid / therapeutic use
  • Combined Modality Therapy
  • Double-Blind Method
  • Early Ambulation*
  • Eating*
  • Humans
  • Length of Stay
  • Los Angeles
  • Middle Aged
  • Pancreatitis / diagnosis
  • Pancreatitis / therapy*
  • Patient Readmission
  • Prospective Studies
  • Recovery of Function
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome
  • Young Adult

Substances

  • Analgesics
  • Analgesics, Opioid

Associated data

  • ClinicalTrials.gov/NCT02813876