Faculty Collaboration Database

Optimizing nutritional support in acute pancreatitis: A systematic review and network meta-analysis of timing and route of feeding. Pancreatology 2026 Jun;26(4):539-551

Date

05/01/2026

Pubmed ID

42062193

DOI

10.1016/j.pan.2026.04.004

Scopus ID

2-s2.0-105040574581 (requires institutional sign-in at Scopus site)

Abstract

BACKGROUND: Acute pancreatitis (AP) is a common inflammatory condition with significant morbidity and mortality. Nutritional management is central to treatment, but uncertainties remain regarding the optimal timing and route of feeding.

METHODS: We conducted a systematic review and network meta-analysis of randomized controlled trials (RCTs) assessing feeding strategies in AP. Databases searched included PubMed, Embase, Scopus, Web of Science, and CENTRAL up to July 2025. Eligible interventions included very early oral feeding (VEOF), early oral feeding (EOF), delayed oral feeding (DOF), early enteral nutrition (EEN), delayed enteral nutrition (DEN), and parenteral nutrition (PN). Risk of bias was assessed using the Cochrane RoB 2 tool. The network and pairwise meta-analysis were conducted using R (version 4.4.3). PROSPERO (CRD420251152683).

RESULTS: Twenty-three RCTs involving 2095 patients were analyzed. EOF demonstrated the most significant mortality reduction compared with PN (RR 0.06, 95% CI 0.00-0.68; SUCRA 92%). DOF (RR 0.19, 95% CI 0.06-0.58) and EEN (RR 0.31, 95% CI 0.17-0.58) also reduced mortality. MOF risk was significantly reduced with DOF (RR 0.25, 95% CI 0.08-0.79) and EEN (RR 0.32, 95% CI 0.20-0.51). No intervention significantly affected sepsis, necrosis, or overall complications. VEOF reduced C-reactive protein (MD -47.3 mg/L, 95% CI -89.8 to -4.8) and LOHS (MD -4.3 days, 95% CI -8.1 to -0.4).

CONCLUSION: EOF should be prioritized in AP as it offers the most substantial mortality benefit while preserving gut integrity and reducing inflammation. DOF and EEN strategies remain effective alternatives, and rhubarb-supplemented EEN may further reduce the length of hospital stay.

Author List

Elhady MM, Rifai M, Nada EA, AlSamhori ARF, Alqudah M, Elgendy A, Awad A, Abuelazm M, Elkhattib I, Elnaggar M

Author

Ismail Elkhattib MBA, MD Assistant Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Disease
Enteral Nutrition
Humans
Nutritional Support
Pancreatitis
Parenteral Nutrition
Randomized Controlled Trials as Topic
Time Factors