Advertisement

Revised Atlanta Classification of Acute Pancreatitis

  • Rupjyoti Talukdar
  • Santhi Swaroop VegeEmail author
Chapter
  • 1.9k Downloads

Abstract

A revision of the original Atlanta Classification from 1992 was long awaited. With better understanding of the natural history and availability of better imaging tools, several limitations of this classification have been noted in different studies. In order to address these limitations and to propose a uniform classification based on modern concepts of acute pancreatitis (AP), an international working group initiated the process of a web-based reiterative consensus process in 2007. The consensus was published as the Revision of the Atlanta Classification of AP in 2013. According to the revised classification, AP has an early and a late phase with distinct clinical courses. Clear definitions of local and systemic complications have been proposed, and new terminologies for collections (acute peripancreatic fluid collections, pancreatic pseudocyst, acute necrotic collection, and walled-off necrosis) have been introduced. The severity of AP has been classified into three distinct categories, namely mild AP, moderately severe AP, and severe AP. This classification of severity is based on the presence or absence of local complications and organ failure and has been shown to have different clinical outcomes. Organ failure has been divided into transient (<48 h) and persistent (>48 h) and the presence of only persistent organ failure qualifies the disease to be labeled as severe AP.

Keywords

Acute Pancreatitis Systemic Inflammatory Response Syndrome Acute Pancreatitis Severe Acute Pancreatitis Local Complication 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Bradley III EL. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, GA, September 11 through 13, 1992. Arch Surg. 1993;128:586–90.PubMedCrossRefGoogle Scholar
  2. 2.
    Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101:2379–400.PubMedCrossRefGoogle Scholar
  3. 3.
    Bollen TL, van Santvoort HC, Besselink MG, van Leeuwen MS, Horvath KD, Freeny PC, et al. The Atlanta classification of acute pancreatitis revisited. Br J Surg. 2008;95:6–21.PubMedCrossRefGoogle Scholar
  4. 4.
    Banks PA, Bolen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis-2102: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102–11.PubMedCrossRefGoogle Scholar
  5. 5.
    Buter A, Imrie CW, Carter CR, Evans S, McKay CJ. Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis. Br J Surg. 2002;89:298–302.PubMedCrossRefGoogle Scholar
  6. 6.
    Johnson CD, Abu-Hilal M. Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis. Gut. 2004;53:1340–4.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Muckart DJ, Bhagwanjee S. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference definitions of the systemic inflammatory response syndrome and allied disorders in relation to critically injured patients. Crit Care Med. 1997;25:1789–95.PubMedCrossRefGoogle Scholar
  8. 8.
    Mofidi R, Duff MD, Wigmore SJ, Madhavan KK, Garden OJ, Parks RW. Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Br J Surg. 2006;93:738–44.PubMedCrossRefGoogle Scholar
  9. 9.
    Singh VK, Wu BU, Bollen TL, Repas K, Maurer R, Mortele KJ, et al. Early systemic inflammatory response syndrome is associated with severe acute pancreatitis. Clin Gastroenterol Hepatol. 2009;7:1247–51.PubMedCrossRefGoogle Scholar
  10. 10.
    Lytras D, Manes K, Triantopoulou C, Paraskeva C, Delis S, Avgerinos C, et al. Persistent early organ failure: defining the high risk group of patients with severe acute pancreatitis. Pancreas. 2008;36:249–54.PubMedCrossRefGoogle Scholar
  11. 11.
    Perez A, Whang EE, Brooks DC, Moore Jr FD, Hughes MD, Sica GT, et al. Is severity of necrotizing pancreatitis increased in extended necrosis and infected necrosis? Pancreas. 2002;25:229–33.PubMedCrossRefGoogle Scholar
  12. 12.
    Vege SS, Gardner TB, Chari ST, Munukuti P, Pearson RK, Clain JE, et al. Low mortality and high morbidity in severe acute pancreatitis without organ failure: a case for revising the Atlanta classification to include “moderately severe acute pancreatitis”. Am J Gastroenterol. 2009;104:710–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Spanier BWM, Nio Y, van der Hulst RWN, Tuynman HA, Dijkgraaf MG, Bruno MJ. Practice and yield of early CT scan in acute pancreatitis: a Dutch observational multicenter study. Pancreatology. 2010;10:222–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Bollen TL, Singh VK, Maurer R, Repas K, van Es HW, Banks PA, et al. A comparative evaluation of radiologic and clinical scoring systems in the early prediction of severity of acute pancreatitis. Am J Gastroenterol. 2012;107:612–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Isenmann R, Buechler M, Uhl W, Malfertheiner P, Martini M, Beger HG. Pancreatic necrosis: an early finding in severe acute pancreatitis. Pancreas. 1993;8:358–61.PubMedCrossRefGoogle Scholar
  16. 16.
    Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990;174:331–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Besselink MG, van Santvoort HC, Boermeester MA, Nieuwenhuijs VB, van Goor H, Dejong CH, et al. Timing and impact of infections in acute pancreatitis. Br J Surg. 2009;96:267–73.PubMedCrossRefGoogle Scholar
  18. 18.
    van Santvoort HC, Bakker OJ, Bollen TL, Besselink MG, Ahmed Ali U, Schrijver AM, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology. 2011;141:1254–63.PubMedCrossRefGoogle Scholar
  19. 19.
    Beger HG, Bittner R, Block S, Büchler M. Bacterial contamination of pancreatic necrosis. A prospective clinical study. Gastroenterology. 1986;91:433–8.PubMedGoogle Scholar
  20. 20.
    Petrov MS, Shanbhag S, Chakraborty M, Phillips AR, Windsor JA. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterology. 2010;139:813–20.PubMedCrossRefGoogle Scholar
  21. 21.
    Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23:1638–52.PubMedCrossRefGoogle Scholar
  22. 22.
    Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707–10.PubMedCrossRefGoogle Scholar
  23. 23.
    Lenhart DK, Balthazar EJ. MDCT of acute mild (nonnecrotizing pancreatitis): abdominal complications and fate of fluid collections. Am J Roentgenol. 2008;190:643–9.CrossRefGoogle Scholar
  24. 24.
    Pelaez-Luna M, Vege SS, Petersen BT, Chari ST, Clain JE, Levy MJ, et al. Disconnected pancreatic duct syndrome in severe acute pancreatitis: clinical and imaging characteristics and outcomes in a cohort of 31 cases. Gastrointest Endosc. 2008;68:91–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Singh VK, Bollen TL, Wu BU, Repas K, Maurer R, Yu S, Mortele KJ, et al. An assessment of the severity of interstitial pancreatitis. Clin Gastroenterol Hepatol. 2011;9:1098–103.PubMedCrossRefGoogle Scholar
  26. 26.
    Talukdar R, Clemens M, Vege SS. Moderately severe acute pancreatitis: prospective validation of this new subgroup of acute pancreatitis. Pancreas. 2012;41:306–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Tenner S, Sica G, Hughes M, Noordhoek E, Feng S, Zinner M, et al. Relationship of necrosis to organ failure in severe acute pancreatitis. Gastroenterology. 1997;113:899–903.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of GastroenterologyAsian Institute of GastroenterologyHyderabadIndia
  2. 2.Division of Gastroenterology and HepatologyMayo ClinicRochesterUSA

Personalised recommendations