Efficacy of early enteral nutrition in patients with severe acute pancreatitis: A prospective cohort study

doi:10.4240/wjgs.v18.i3.115972

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World Journal of Gastrointestinal Surgery

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World J Gastrointest Surg. Mar 27, 2026; 18(3): 115972
Published online Mar 27, 2026. doi: 10.4240/wjgs.v18.i3.115972

Efficacy of early enteral nutrition in patients with severe acute pancreatitis: A prospective cohort study

Mei-Lan Jiang, Jian-Ping Bao, Si-Cong Jiang, Fang-Gen Xu

Mei-Lan Jiang, Jian-Ping Bao, Fang-Gen Xu, Department of Gastroenterology, Gaoxin Branch of the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China

Si-Cong Jiang, Division of Thoracic and Endocrine Surgery, University Hospitals and University of Geneva, Geneva 41211, Switzerland

Author contributions: Jiang ML contributed to study conception and design, data acquisition, statistical analysis, and drafting of the manuscript; Bao JP and Jiang SC participated in patient enrollment, data collection, and interpretation of clinical outcomes; Xu FG supervised the study, provided critical revision of the manuscript for important intellectual content, and served as the corresponding author. All authors read and approved the final manuscript.

Supported by Application for Key Discipline Construction Project of High Tech Hospital, First Affiliated Hospital of Nanchang University, No. GX2D20247402.

Institutional review board statement: This study has been reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Nanchang University.

Clinical trial registration statement: This study was conducted prospectively. According to the characteristics of the study design, it was not registered in a clinical trial registry prior to initiation.

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: The authors declare no conflicts of interest.

CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.

Data sharing statement: If you need data, please contact the corresponding author.

Corresponding author: Fang-Gen Xu, MD, Department of Gastroenterology, Gaoxin Branch of the First Affiliated Hospital of Nanchang University, No. 7889 Changdong Avenue, High Tech Zone, Nanchang 330006, Jiangxi Province, China. 13607988780@163.com

Received: December 2, 2025
Revised: January 1, 2026
Accepted: January 19, 2026
Published online: March 27, 2026
Processing time: 115 Days and 3.4 Hours

Abstract

BACKGROUND

Severe acute pancreatitis (SAP) is linked to substantial morbidity and mortality. Early enteral nutrition (EEN) has emerged as a potential therapeutic approach to preserve gut barrier function and decrease complications.

AIM

To compare the efficacy and safety of enteral nutrition (EN) initiated within vs after 48 hours in SAP.

METHODS

This prospective cohort study was conducted from January 2024 to December 2025, involving 100 patients diagnosed with SAP. The patients were segregated into two groups: The EEN group (n = 52), who received EN within 48 hours, and the delayed EN (DEN) group (n = 48), who received EN after 48 hours. The primary outcomes assessed were mortality, infectious complications, length of hospital stay, and organ failure. Secondary outcomes encompassed feeding intolerance, markers of intestinal permeability, and nutritional status.

RESULTS

The EEN group exhibited significantly lower mortality (5.8% vs 18.8%, P < 0.05), decreased infectious complications (17.3% vs 37.5%, P < 0.01), and shorter hospital stay (18.6 ± 6.2 days vs 26.4 ± 8.5 days, P < 0.001) compared to the DEN group. The EEN group also had a significantly lower incidence of organ failure (23.1% vs 45.8%, P < 0.01). Intestinal permeability markers indicated a quicker recovery in the EEN group. The rates of feeding intolerance were similar between the groups (13.5% vs 16.7%, P > 0.05).

CONCLUSION

EEN initiated within 48 hours significantly enhances clinical outcomes in patients with SAP by decreasing mortality, infectious complications, and organ failure, and facilitating quicker recovery of gut barrier function.

Keywords: Severe acute pancreatitis; Early enteral nutrition; Delayed enteral nutrition; Mortality; Infectious complications; Gut barrier function

Core Tip: This prospective cohort study evaluated the effects of early enteral nutrition (EEN), which was initiated within 48 hours, on clinical outcomes in patients with severe acute pancreatitis (SAP). In comparison to delayed enteral nutrition (EN), EEN notably decreased mortality, infectious complications, and organ failure, while also reducing hospitalization duration and enhancing the restoration of gut barrier function. The incidence of feeding intolerance did not rise with the prompt initiation of therapy. These results underscore the importance of timely EN as a secure and efficient therapeutic approach to enhance the prognosis of SAP patients, emphasizing its significance in clinical care.