Eleven RCTs were included in the review (n=451, range 17 to 89). Six studies were considered good quality. All studies reported randomisation, but three did not describe how treatment was assigned. Ten described withdrawals and dropouts. None were double-blinded.
Enteral versus parenteral nutrition among patients with mild or severe pancreatitis: Enteral nutrition started within 48 hours of admission was associated with significantly less risk than parenteral nutrition of multiple organ failure (RR 0.44, 95% CI 0.23 to 0.84; three RCTs), pancreatic infectious complications (RR 0.46, 95% CI 0.27 to 0.77; five RCTs) or mortality (RR 0.46, 95% CI 0.20 to 0.99; five RCTs). Findings were similar when nutrition was initiated within 24 hours of admission (four RCTs). When nutrition was initiated more than 48 hours after admission (four RCTs), the difference between the groups was no longer statistically significant. Statistical heterogeneity was low or absent for these analyses.
Early versus delayed nutrition among patients with mild or severe pancreatitis: There was no statistically significant interaction between early versus delayed groups for any outcome at either time threshold. There was a trend for greater risk reduction associated with delayed nutrition for the outcome of pancreatic infectious complications, but not for other outcomes.
The results of the subgroup analysis were reported.