Nutrition support is a key method to treat acute pancreatitis (AP). Enteral nutrition (EN) has a role in treating AP, but the time point for EN initiation remains unclear. The present systematic review and meta‑analysis aimed to assess the efficacy of early EN (EEN) and delayed EN (DEN) based on different time points (24, 48 and 72 h). The relevant databases including Pubmed, Web of Science, Embase and Cochrane library were searched until Dec 1, 2022. Studies comparing EEN and DEN in AP were included. The relative risk (RR) was used for comparing categorical variables, while standard mean difference (SMD) was used for continuous variables, both reported with 95% CI. A total of 17 studies with 1,637 patients with AP was included in the present systematic review and meta‑analysis. The patients in the DEN group showed a significantly higher risk of mortality compared with the EEN group (RR=1.95; 95% CI, 1.21‑3.14; P=0.006). In subgroup analysis, when using 48 h as the cut‑off time to distinguish EEN and DEN, the risk of mortality was 3.89‑fold higher in the DEN group compared with that in the EN group (95% CI, 1.25‑12.17; P=0.019). DEN also increased the occurrence of sepsis in patients with AP (RR=2.82; 95% CI, 1.10‑7.18; P=0.03) and duration of hospital stay (P<0.001). The present systematic review and meta‑analysis suggested that EEN decreased associated complications, length of hospitalization and mortality in patients with AP and therefore provided a safe approach to improve recovery but there is still controversy around the time point for EEN.

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