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 y) with predicted SAP (BISAP score ≥2) from 05/2011-07/2023. 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 Chi-square, Fisher exact tests, and two-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. Post-pyloric 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.