Outcomes of Early Enteral Feeding (<48 Hours) in Patients With Predicted Severe Acute Pancreatitis

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.