Early versus On-Demand Tube Feeding in Pancreatitis

To the Editor: Bakker et al. (Nov. 20 issue)¹ found no benefit of early enteral nutrition in patients with predicted severe acute pancreatitis. Clinical trials involving patients with this condition are hampered by the low positive predictive value of current prognostic scoring systems, resulting in the inclusion of many patients who ultimately have mild acute pancreatitis and do not require early enteral nutrition.² A composite end point allowed for sample-size reduction but ultimately resulted in an underpowered study, owing to the inequality between the individual end points.³ Death and infection have vastly different clinical significance, given that persistent organ failure, . . .