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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Mar 27, 2026 (publication date) through Mar 30, 2026

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Prospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

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

Table 1 Baseline demographic and clinical characteristics, n (%)

Variable	EEN group (n = 52)	DEN group (n = 48)	P value
Age (years), mean ± SD	48.3 ± 14.2	50.1 ± 13.8	0.512
Male gender	34 (65.4)	30 (62.5)	0.756
BMI (kg/m²), mean ± SD	24.8 ± 3.6	25.3 ± 3.9	0.493
Etiology			0.897
Biliary	24 (46.2)	21 (43.8)
Alcoholic	17 (32.7)	17 (35.4)
Hypertriglyceridemia	6 (11.5)	5 (10.4)
Idiopathic	5 (9.6)	5 (10.4)
Comorbidities
Diabetes mellitus	12 (23.1)	10 (20.8)	0.776
Hypertension	18 (34.6)	16 (33.3)	0.889
Hyperlipidemia	9 (17.3)	8 (16.7)	0.930
APACHE II score, mean ± SD	12.4 ± 3.8	12.8 ± 4.1	0.603
Balthazar CT severity index, mean ± SD	6.2 ± 1.8	6.5 ± 1.9	0.415
WBC count (× 10⁹/L), mean ± SD	14.2 ± 4.3	14.8 ± 4.6	0.499
Serum amylase (U/L), mean ± SD	862 ± 346	894 ± 372	0.651
C-reactive protein (mg/L), mean ± SD	186 ± 72	192 ± 78	0.684

BMI: Body mass index; APACHE: Acute Physiology and Chronic Health Evaluation; CT: Computed tomography; WBC: White blood cells; DEN: Delayed enteral nutrition; EEN: Early enteral nutrition.

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Table 2 Primary clinical outcomes between early enteral nutrition and delayed enteral nutrition groups, n (%) or mean ± SD

Outcome	EEN group (n = 52)	DEN group (n = 48)	P value
Mortality	3 (5.8)^a	9 (18.8)^b	0.038
Infectious complications	9 (17.3)^a	18 (37.5)^b	0.019
Infected pancreatic necrosis	4 (7.7)^a	11 (22.9)^b	0.028
Bacteremia	2 (3.8)	4 (8.3)	0.335
Pneumonia	2 (3.8)	5 (10.4)	0.191
Urinary tract infection	1 (1.9)	2 (4.2)	0.515
Length of hospital stay (days)	18.6 ± 6.2^a	26.4 ± 8.5^b	< 0.001
Persistent organ failure	12 (23.1)^a	22 (45.8)^b	0.014
Respiratory failure	6 (11.5)^a	14 (29.2)^b	0.022
Cardiovascular failure	5 (9.6)^a	12 (25.0)^b	0.036
Renal failure	4 (7.7)	8 (16.7)	0.162
ICU admission	18 (34.6)	24 (50.0)	0.113
ICU length of stay (days)	6.8 ± 3.4^a	10.2 ± 5.1^b	0.006

^aP < 0.05 vs the delayed enteral nutrition group.

^bP < 0.05 vs the early enteral nutrition group.

EEN: Early enteral nutrition; DEN: Delayed enteral nutrition; ICU: Intensive care unit.

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Table 3 Secondary outcomes and nutritional parameters, n (%) or mean ± SD

Outcome	EEN group (n = 52)	DEN group (n = 48)	P value
Feeding intolerance	7 (13.5)	8 (16.7)	0.645
Time to full nutrition (days)	4.2 ± 1.6^a	8.5 ± 2.8^b	< 0.001
Local complications
Pancreatic necrosis	16 (30.8)	18 (37.5)	0.473
Peripancreatic fluid collections	22 (42.3)	24 (50.0)	0.435
Pancreatic pseudocyst	5 (9.6)	7 (14.6)	0.434
Interventional procedures	8 (15.4)^a	16 (33.3)^b	0.031
Albumin (g/L)
Baseline	36.4 ± 5.2	35.8 ± 5.6	0.579
Day 7	34.8 ± 4.6^a	31.2 ± 5.8^b	0.001
Day 14	33.2 ± 4.8^a	28.6 ± 5.4^b	< 0.001
Prealbumin (mg/L)
Baseline	186 ± 42	182 ± 46	0.646
Day 7	168 ± 38^a	142 ± 44^b	0.002
Day 14	172 ± 36^a	136 ± 48^b	< 0.001
C-reactive protein day 7 (mg/L)	82 ± 34^a	126 ± 52^b	< 0.001
Procalcitonin day 7 (ng/mL)	1.8 ± 0.9^a	3.6 ± 1.8^b	< 0.001

^aP < 0.05 vs the delayed enteral nutrition group.

^bP < 0.05 vs the early enteral nutrition group.

EEN: Early enteral nutrition; DEN: Delayed enteral nutrition.

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Table 4 Intestinal permeability and inflammatory markers, mean ± SD

Parameter	EEN group (n = 52)	DEN group (n = 48)	P value
Lactulose/mannitol ratio
Baseline	0.186 ± 0.062	0.192 ± 0.068	0.641
Day 7	0.082 ± 0.028^a	0.124 ± 0.042^b	< 0.001
Diamine oxidase (U/L)
Baseline	18.4 ± 5.6	19.2 ± 6.2	0.509
Day 7	8.6 ± 3.2^a	12.4 ± 4.8^b	< 0.001
C-reactive protein (mg/L)
Baseline	186 ± 72	192 ± 78	0.684
Day 3	142 ± 56^a	178 ± 68^b	0.004
Day 7	82 ± 34^a	126 ± 52^b	< 0.001
Procalcitonin (ng/mL)
Baseline	4.8 ± 2.2	5.2 ± 2.6	0.414
Day 7	1.8 ± 0.9^a	3.6 ± 1.8^b	< 0.001
WBC count (× 10⁹/L)
Baseline	14.2 ± 4.3	14.8 ± 4.6	0.499
Day 7	9.2 ± 2.8^a	12.6 ± 4.2^b	< 0.001
Endotoxin (EU/mL)
Baseline	0.42 ± 0.16	0.45 ± 0.18	0.384
Day 7	0.18 ± 0.08^a	0.32 ± 0.14^b	< 0.001

^aP < 0.05 vs the delayed enteral nutrition group.

^bP < 0.05 vs the early enteral nutrition group.

WBC: White blood cell; EU: Endotoxin units; EEN: Early enteral nutrition; DEN: Delayed enteral nutrition.

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Table 5 Outcomes stratified by etiology, n (%) or mean ± SD

Etiology and outcome	EEN group	DEN group	P value
Biliary pancreatitis	n = 24	n = 21
Mortality	1 (4.2)^a	4 (19.0)^b	0.041
Infectious complications	4 (16.7)^a	8 (38.1)^b	0.039
Hospital stay (days)	17.2 ± 5.8^a	24.6 ± 7.9^b	0.002
Organ failure	5 (20.8)^a	10 (47.6)^b	0.038
Alcoholic pancreatitis	n = 17	n = 17
Mortality	1 (5.9)^a	3 (17.6)^b	0.042
Infectious complications	2 (11.8)^a	6 (35.3)^b	0.016
Hospital stay (days)	19.8 ± 6.4^a	27.2 ± 8.8^b	0.006
Organ failure	4 (23.5)	7 (41.2)	0.274
Hypertriglyceridemia	n = 6	n = 5
Mortality	0 (0.0)	1 (20.0)	0.455
Infectious complications	1 (16.7)	2 (40.0)	0.524
Hospital stay (days)	20.5 ± 7.2	28.8 ± 9.6	0.178
Organ failure	2 (33.3)	3 (60.0)	0.524
Idiopathic pancreatitis	n = 5	n = 5
Mortality	1 (20.0)	1 (20.0)	1.000
Infectious complications	2 (40.0)	2 (40.0)	1.000
Hospital stay (days)	18.6 ± 6.8	26.4 ± 10.2	0.246
Organ failure	1 (20.0)	2 (40.0)	0.524

^aP < 0.05 vs the delayed enteral nutrition group.

^bP < 0.05 vs the early enteral nutrition group.

EEN: Early enteral nutrition; DEN: Delayed enteral nutrition.

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Table 6 Multivariate analysis of mortality risk factors

Variable	Odds ratio	95%CI	P value
Delayed enteral nutrition	3.84	1.12-13.16	0.032
APACHE II score > 15	5.23	1.68-16.28	0.004
Organ failure at admission	4.76	1.42-15.94	0.011
Age > 60 years	2.98	0.94-9.45	0.064
Male gender	1.42	0.48-4.21	0.527
Biliary etiology	0.86	0.28-2.64	0.793
Alcoholic etiology	1.12	0.34-3.68	0.853
BMI > 30 kg/m²	1.76	0.52-5.93	0.365
Diabetes mellitus	1.58	0.48-5.21	0.451
Pancreatic necrosis > 30%	2.34	0.76-7.21	0.138

CI: Confidence interval; APACHE: Acute Physiology and Chronic Health Evaluation; BMI: Body mass index.

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Citation: Jiang ML, Bao JP, Jiang SC, Xu FG. Efficacy of early enteral nutrition in patients with severe acute pancreatitis: A prospective cohort study. World J Gastrointest Surg 2026; 18(3): 115972
URL: https://www.wjgnet.com/1948-9366/full/v18/i3/115972.htm
DOI: https://dx.doi.org/10.4240/wjgs.v18.i3.115972