Role of early enteral feeding in mild and moderate acute pancreatitis


  • Aswin George Roy Department of General Surgery, Government Medical College, Thrissur, Kerala, India
  • Haridas T. V. Department of General Surgery, Government Medical College, Thrissur, Kerala, India



Acute pancreatitis, Early enteral feeding, Delayed enteral feeding, Total parenteral nutrition


Background: Timing of enteral feeding in acute pancreatitis was always a matter of controversy. Increasing evidence suggests that early enteral feeding reduces systemic and local complications of pancreatitis and thereby hospital stay. Hence the study has been undertaken to determine the feasibility, advantages and disadvantages of early enteral feeding in mild and moderate acute pancreatitis. 

Methods: Patients admitted with symptoms and signs suggestive of mild and moderate acute pancreatitis who were started on early enteral feeding (within 48 hours of admission) were included in study. Blood investigation results are used to classify patients accordingly to mild and moderate acute pancreatitis based on Ransons’s score. Patients were followed up and categorized based on development of complications, length of hospital stay.

Results: Majority of the patients who were started on early enteral feeding showed significant decrease in complications and hospital stay. Study also suggested that age is a significant risk in development of complications. Gender is not significant in the development of complications.

Conclusions: There is significant decrease in rate of systemic complication, local infective and non-infective complications, length of hospital stay among acute pancreatitis patients who were started on early enteral feeding (within 48 hours).

Author Biographies

Aswin George Roy, Department of General Surgery, Government Medical College, Thrissur, Kerala, India

Department of General Surgery, Senior Resident

Haridas T. V., Department of General Surgery, Government Medical College, Thrissur, Kerala, India

Department of General Surgery, Associate professor


Warren M, McCarthy MS, Roberts PR. Practical application of the revised guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: a case study approach. Nut Clin Pract: Off Publ Am Soc Parent Enter Nutr. 2016;31:334-41.

Qiao SF, Lu TJ, Sun JB. Alterations of intestinal immune function and regulatory effects of L-arginine in experimental severe acute pancreatitis rats. World J Gastroenterol. 2005;11:6216-8.

Schwarz M, Thomsen J, Meyer H. Frequency and time course of pancreatic and extrapancreatic bacterial infection in experimental acute pancreatitis in rats. Surgery. 2000;127:427-32.

Luo XJ, Peng Y. Enteral nutrition in severe acute pancreatitis. World Chinese J Digest. 2014;22:1658-62.

Ekelund M, Kristensson E, Ekelund M. Total parenteral nutrition causes circumferential intestinal atrophy, remodeling of the intestinal wall, and redistribution of eosinophils in the rat gastrointestinal tract. Digest Dis Sci. 2007;52;1833-9.

Hua Z, Su Y, Huang X. Analysis of risk factors related to gastrointestinal fistula in patients with severe acute pancreatitis: a retrospective study of 344 cases in a single Chinese center. BMC gastroenterol. 2017;17:29.

McClave SA, Greene LM, Snider HL, Makk LJ, Cheadle WG, Owens NA et al. Comparison of the safety of early enteral vs parenteral nutrition in mild acute pancreatitis. JPEN J Parenter Enteral Nutr. 1997;21:14-20.

Petrov MS, Pylypchuk RD, Uchugina AF. A systematic review on the timing of artificial nutrition in acute pancreatitis. Br J Nutr. 2009;101:787-93.

Marik PE. What is the best way to feed patients with pancreatitis? Curr Opin Crit Care. 2009;15:131-8.

Gupta R, Patel K, Calder PC, Yaqoob P, Primrose JN, Johnson CD. A randomised clinical trial to assess the effect of total enteral and total parenteral nutritional support on metabolic, inflammatory and oxidative markers in patients with predicted severe acute pancreatitis (APACHE II & gt). Pancreatology. 2003;3:406-13.

Zou L, Ke L, Li W. Enteral nutrition within 72 h after onset of acute pancreatitis vs. delayed initiation. Eur J Clin Nutr. 2014;68(12):1288-93.

Eckerwall GE, Axelsson JB, Andersson RG. Early nasogastric feeding in predicted severe acute pancreatitis: A clinical, randomized study. Ann Surg. 2006;244(6):959-65.

Louie BE, Noseworthy T, Hailey D. 2004 MacLean-Mueller prize enteral or parenteral nutrition for severe pancreatitis: a randomized controlled trial and health technology assessment. Can J Surg. 2005;48(4):298-306.

Olah A, Pardavi G, Belagyi T. Early nasojejunal feeding in acute pancreatitis is associated with a lower complication rate. Nutrition. 2002;18(3):259-62.

Kalfarentzos F, Kehagias J, Mead N. Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial. Br J Surg. 1997;84(12):1665-9.

Casas M, Mora J, Fort E. Total enteral nutrition vs. total parenteral nutrition in patients with severe acute pancreatitis. Rev Esp Enferm Dig. 2007;99(5):264-9.

Abou-Assi S, Craig K, O’Keefe SJ. Hypocaloric jejunal feeding is better than total parenteral nutrition in acute pancreatitis: results of a randomized comparative study. Am J Gastroenterol. 2002;97(9):2255.

Sun JK, Mu XW, Li WQ, Tong ZH, Li J, Zheng SY. Effects of early enteral nutrition on immune function of severe acute pancreatitis patients. World J Gastroenterol. 2013;19:917-22.

Eckerwall GE, Tingstedt BB, Bergenzaun PE, Andersson RG. Immediate oral feeding in patients with mild acute pancreatitis is safe and may accelerate recovery-a randomized clinical study. Clin Nutr. 2007;26:758-63.

Li JY, Yu T, Chen GC, Yuan YH, Zhong W, Zhao LN et al. Enteral nutrition within 48 hours of admission improves clinical outcomes of acute pancreatitis by reducing complications: a meta-analysis. PLoS One. 2013;8:e64926.






Original Research Articles