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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
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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: Bechien.U.Wu@kp.org).

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 http://clinicaltrials.gov NCT02813876.

The institutional review board approved the study in December 2015.

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