title: Early enteral nutrition is superior to delayed enteral nutrition for the prevention of infected necrosis and mortality in acute pancreatitis.
abstract: OBJECTIVE
  The exact time of initiation of total enteral nutrition (TEN) in severe acute pancreatitis (SAP) and its influence on the disease outcome are not well known.
  
  
  METHODS
  An analysis of 197 cases with predicted SAP allocated to: group A (n = 97), early TEN (started within the first 48 hours after admission to hospital); and group B (n = 100), delayed TEN (started after 48 hours).
  
  
  RESULTS
  Infection of necrosis/fluid collections occurred in 4 patients in group A and 18 patients in group B (P < 0.05). Respiratory failure and transfer to intensive care unit occurred more frequently in group B than in group A (15 vs 5 and 15 vs 3 patients; P < 0.05). Multiple-organ failure was observed in 9 patients in group A and 16 patients in group B (P > 0.05). Seven patients in group A and 11 patients in group B underwent surgery (P > 0.05). All 9 reported deaths occurred in group B (P < 0.05). The time to start TEN was a predictor of infected necrosis/fluid collection (odds ratio, 4.09; P = 0.028).
  
  
  CONCLUSIONS
  Delayed compared to early TEN is associated with higher mortality, increased frequency of infected necrosis/fluid collections, respiratory failure, and a need for intensive care unit hospitalization. Enteral nutrition in SAP should be started within 48 hours after admission to hospital.
authors.affiliation: Department of Gastroenterology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland.
authors.forename: Urszula
authors.initials: U
authors.lastname: Wereszczynska-Siemiatkowska
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Swidnicka-Siergiejko
authors.forename: Andrzej
authors.initials: A
authors.lastname: Siemiatkowski
authors.forename: Andrzej
authors.initials: A
authors.lastname: Dabrowski
mesh_terms: D000328:Adult; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D019283:Pancreatitis, Acute Necrotizing / Q000382:microbiology / Q000517:prevention & control; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors