Early feeding in Post-endoscopic retrograde cholangiopancreatography pancreatitis: a randomized controlled trial

초록

Background: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a frequent complication affecting 5–10% of ERCP patients. While early oral refeeding (ERF) has shown promising results in acute pancreatitis (AP), its impact on PEP remains unexplored. Thus, our study assesses the safety and efficacy of ERF versus delayed refeeding (DRF) in mild PEP patients. Methods: In this multicenter trial, eligible patients were randomly assigned in a 1:1 ratio to ERF or DRF groups. ERF began 24 hours after PEP diagnosis, while DRF started after normal bowel sounds and reduced pain. The diet progressed from sips of water to soft food, considering tolerance. Refeeding paused if pain reached ≥5 points or if intake was refused due to pain. Resumption required normal amylase/lipase levels, pain relief, and restored bowel movement. Discharge criteria included patient well-being >24 hours post-diet. Primary outcome included PEP hospitalization duration; secondary outcomes included severe AP, readmission rate (<30 days), and PEP-related mortality/morbidity rates. Results: Between February 2021 and December 2022, 80 patients (40 in each ERF and DRF group) were enrolled in 9 referral centers. Baseline characteristics and procedural parameters showed no significant differences between groups. Initial PEP severity was similar. During refeeding, four ERF and three DRF patients had refeeding interruptions. ERF significantly reduced PEP hospitalization duration compared to DRF (2.9±1.6 vs. 3.8±2.0 days, p=0.032). Rates of severe AP, readmission (<30 days), and mortality/morbidity related to PEP were similar between groups. Conclusion: Early oral refeeding significantly reduced PEP patients’ hospital stays and did not increase PEP-related safety issues.