Oral Presentation The Pancreas Summit 2025

Randomized Controlled Trial of Immediate Full Calorie Regular Diet (RD) Versus Clear Liquid Diet (CLD) for Mild to Moderate Acute Pancreatitis (125737)

James Buxbaum 1 , Sean Dewberry 1 , Linda Huang 2 , Andrew Tarakji 1 , Daniel Wang 1 , Cameron Quon 1 , Jordan Stellern 1 , Harry Trieu 1 , Niwen Kong 1 , Patrick Chang 1
  1. University of Southern California, South Pasadena, CA, United States
  2. Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

INTRODUCTION
Small studies suggest a benefit of early oral feeding in the setting of acute pancreatitis (AP). However, clinical equipoise and lack of large studies has limited widespread implementation of this strategy. The aim of this large randomized controlled trial was to compare the efficacy of immediate regular diet (RD) versus clear liquid diet (CLD) with stepwise advancement in AP.

METHODS
Patients presenting to the emergency department (ED) with mild to moderate AP were prospectively randomized (1:1) within 16 hours of AP diagnosis to receive either CLD or RD. Randomization was stratified by etiology (gallstone vs. non-gallstone). Patients were excluded if they had severe pancreatitis based on the Revised Atlanta Classification (RAC).

Patients were assessed at each meal for pain, nausea, and percentage of meal tolerated and their detailed clinical course was captured by coordinators blinded to assignment.

The study's primary outcome was length of hospital stay defined as the time from ED triage to discharge. Secondary endpoints included relapse in diet, local complications (e.g. pancreatic necrosis, per RAC), development of severe pancreatitis or organ failure (per RAC), and readmission to the hospital within 30 days. Sample size of 150 patients provided 80% power (α=0.05) to detect a 2 day difference in length of stay.

RESULTS

Between 2021 and 2024, 150 patients were randomized. There was no significant difference in baseline characteristics of the CLD and RD groups.

The mean length of stay was shorter for the regular diet group compared to the clear liquid diet group overall (3.41 days vs 4.14 days; mean difference 1.21 [95%CI 0.98-1.51]) and for the gallstone subgroup, (3.99 vs 5.23 days; mean difference 1.24 [95%CI 1.03-1.67]).  There were fewer local complications with regular diet (4.3% vs 13.6%; Odds Ratio 0.29 [95% CI 0.06-0.97]) but no difference in organ failure, diet relapse, or readmission.

CONCLUSION
Our findings suggest that immediate regular diet potentially reduces length of stay and decrease local pancreatic complications in specific patient populations with acute pancreatitis. Early reintroduction of a regular diet may result in these benefits by improving gut barrier integrity, reducing bacterial translocation, and/or mitigating inflammation.