Early Enteral Nutrition versus Delayed Feeding in Acute Pancreatitis: A Prospective Comparative Study

Background: The optimal timing for initiating enteral nutrition in acute pancreatitis remains a subject of ongoing clinical debate. While traditional management advocated prolonged fasting to achieve pancreatic rest, emerging evidence suggests that early enteral feeding may confer significant clinical benefits. This study aimed to compare clinical outcomes between early enteral nutrition and delayed feeding strategies in patients hospitalized with acute pancreatitis. Methods: This prospective comparative study was conducted at a tertiary care hospital. A total of 174 consecutive patients diagnosed with acute pancreatitis were allocated into two groups: the early enteral nutrition group (EEN, n = 88), receiving oral or nasojejunal feeding within 24 hours of admission, and the delayed feeding group (DF, n = 86), receiving nutritional support after 72 hours or upon complete resolution of abdominal pain. Primary outcomes included length of hospital stay, organ failure incidence, and infectious complications. Secondary outcomes included pain resolution time, inflammatory marker trajectories, and mortality. Results: Patients in the EEN group demonstrated significantly shorter hospital stays (7.3 ± 2.9 days vs. 10.6 ± 4.1 days, p < 0.001), lower rates of infectious complications (9.1% vs. 22.1%, p = 0.017), and reduced incidence of organ failure (6.8% vs. 16.3%, p = 0.048). Pain resolution occurred earlier in the EEN group (3.1 ± 1.4 days vs. 4.7 ± 2.1 days, p < 0.001). C-reactive protein levels at day 5 were significantly lower in the EEN group (48.7 ± 31.2 mg/L vs. 79.4 ± 42.6 mg/L, p < 0.001). Mortality rates did not differ significantly between groups (2.3% vs. 4.7%, p = 0.440). Feeding intolerance occurred in 11.4% of EEN patients but was manageable in all cases. Conclusion: Early enteral nutrition within 24 hours of admission in acute pancreatitis is associated with significantly reduced hospital stay, fewer infectious complications, lower organ failure rates, and accelerated clinical recovery compared to delay feeding. These findings support the adoption of early feeding protocols as standard practice in acute pancreatitis management.