Early Enteral Versus Parenteral Nutrition in Acute Severe Pancreatitis

Abstract

Introduction: Acute severe pancreatitis (ASP) causes hypercatabolism. Early enteral nutrition (EN) via nasojejunal tube is recommended over parenteral nutrition (PN), but optimal timing and route remain contested.
Methods: Systematic review of 11 RCTs (n=1,042) comparing early EN (≤48 hours) versus PN or delayed EN (>72 hours) in ASP (Atlanta criteria, APACHE II ≥8). Primary outcomes: mortality, infectious complications (pancreatic necrosis infection, bacteremia). Secondary: length of stay (LOS), multiorgan failure.
Results: Early EN reduced mortality (8.7% vs 15.2%, RR 0.57, 95% CI 0.38–0.86, p=0.007) and infectious complications (26% vs 41%, RR 0.63). PN was associated with higher line sepsis (12% vs 3%). EN delivered via nasogastric was as effective as nasojejunal with less insertion difficulty. Patients with hemodynamic instability or open abdomen had no benefit from early EN.
Discussion: Early EN preserves gut barrier, reduces bacterial translocation. PN should be reserved for EN failure or intestinal obstruction.
Conclusion: Early enteral nutrition (within 48 hours) reduces mortality and infections in acute severe pancreatitis and should be standard.