The timing of feeding after Upper Gastrointestinal (UGI) endoscopic therapies remains variable in the clinical setting. Delayed feeding is traditionally practiced to reduce perceived bleeding risk however may lead to unnecessary prolonged fasting, recovery and hospital stay. The most recent meta-analyses examined the timing of feeding after UGI endoscopic therapies; with one focusing on therapies done for UGI bleeding alone and the other focused on feeding after UGI endoscopic therapy in general. This meta-analysis aims to make an updated comparison of outcomes of early versus delayed feeding following UGI endoscopic procedures across variceal, non-variceal, and combined populations; including the latest randomized controlled trials available and excluding studies with no endoscopic therapy done.

A systematic literature search identified 10 randomized controlled trials (RCTs) comparing early and delayed feeding after UGI endoscopic therapy (e.g. Endoscopic Variceal Ligation, Endoscopic Submucosal Dissection, Sclerotherapy, Endoscopic Injection with Adrenaline, Argon Plasma Coagulation, Thermal coagulation). Early feeding was defined as introduction of standard diet within 24 hours after an UGI endoscopic therapy, while delayed feeding was after 24 hours. Outcomes included early and delayed rebleeding, total rebleeding, mortality, and duration of hospital stay. Using a Mantel–Haenszel random-effects model, pooled risk ratios (RR) were calculated for binary outcomes and standardized mean differences (SMD) for continuous outcomes.  Heterogeneity was assessed using I² statistic and subgroup analyses were conducted for variceal and non-variceal procedures to explore differences of outcomes amongst different patient populations.

Across the 10 RCTs, early feeding did not significantly increase total rebleeding compared with delayed feeding in the combined cohort (RR = 1.20; 95% CI 0.74–1.93; p = 0.47), and showed no observed heterogeneity (I² = 0%). Subgroup analyses showed no significant difference in total rebleeding for variceal (RR = 1.08; 95% CI 0.53–2.22; p = 0.83) or non-variceal procedures (RR = 1.30; 95% CI 0.68–2.48; p = 0.43), both with low heterogeneity. Mortality outcomes were similarly comparable between early and delayed feeding groups (RR = 0.73; 95% CI 0.31–1.70; p = 0.47; I² = 0%). Early feeding significantly reduced hospital stay (SMD = −0.76; 95% CI −1.19 to −0.32; p = 0.0006) though heterogeneity was substantial (I² = 88%).

Early feeding after UGI endoscopic therapy appears safe without increased risk of rebleeding or mortality and is associated with shorter hospitalization. These findings support reconsidering prolonged fasting protocols post-endoscopy while highlighting the need for standardized RCTs to refine optimal feeding timing.