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Enhanced Recovery in Mild Acute Pancreatitis

A Randomized Controlled Trial

Dong, Elizabeth, MD*; Chang, Jonathan I., MD*; Verma, Dhruv, MD*; Butler, Rebecca K., MPH; Villarin, Cecia K., BA; Kwok, Karl K., MD*; Chen, Wansu, PhD; Wu, Bechien U., MD, MPH*

doi: 10.1097/MPA.0000000000001225
Original Articles

Objectives Acute pancreatitis (AP) is a leading cause of hospitalization for a gastrointestinal illness in the United States. We hypothesized that enhanced recovery approaches may lead to earlier time to refeeding in patients with AP.

Methods We performed a double-blind, randomized controlled trial of patients admitted with mild AP from July 2016 to April 2017 at a tertiary medical center. Participants were randomly assigned to receive either enhanced recovery consisting of nonopioid analgesia, patient-directed oral intake, and early ambulation versus standard treatment with opioid analgesia and physician-directed diet. Primary study end point was time to oral refeeding on an intent-to-treat basis. Secondary end points included differences in pancreatitis activity scores, morphine equivalents, length of stay, and 30-day readmissions.

Results Forty-six participants enrolled. Median age was 53.1 years, and 54.3% were female. There was significant reduction in time to successful oral refeeding in the enhanced recovery versus standard treatment group (median, 13.8 vs 124.8 hours, P < 0.001). Pancreatitis activity scores trended lower at 48 to 96 hours among patients assigned to enhanced recovery (mean, 43.6 vs. 58.9, P = 0.32). No differences found in length of stay or 30-day readmissions.

Conclusion In this randomized controlled trial, enhanced recovery was safe and effective in promoting earlier time to refeeding in patients hospitalized with AP.

From the *Division of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles; and

Department of Research and Evaluation, Kaiser Permanente, Pasadena, CA.

Received for publication April 22, 2018; accepted November 10, 2018.

Address correspondence to: Bechien U. Wu, MD, MPH, Kaiser Permanente Los Angeles Medical Center, Center for Pancreatic Care, 1526 Edgemont St Fl 7, Los Angeles, CA 90027 (e-mail:

This study was internally funded by the Regional Research Committee of Kaiser Permanente.

The authors declare no conflict of interest.

Guarantor of the article: Bechien U. Wu.

E.D. contributed to the conduction of the study, data collection, drafting of the manuscript, and critical revision of the manuscript; J.I.C., conduction of the study and data collection; D.V., conduction of the study and data collection; R.K.B., data analysis and interpretation; C.K.V., data collection; K.K.K., conduction of the study and critical revision of the manuscript; W.C., data analysis and interpretation; B.U.W., study concept and design, conduction of study, data collection, data analysis and interpretation, and critical revision of the manuscript.

The trial was registered with NCT02813876.

The institutional review board approved the study in December 2015.

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