Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus

Banks, Peter A.; Bollen, Thomas L.; Dervenis, Christos; Gooszen, Hein G.; Johnson, C. D.; Sarr, Michael G.; Tsiotos, Gregory G.; Vege, Santhi Swaroop

doi:10.1136/gutjnl-2012-302779

Cited by 5,522 publications

(5,877 citation statements)

References 67 publications

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“…and M.M.L.). The classification of the pancreatitis events was decided on by an external expert committee and was in accordance with internationally accepted guidelines (18)(19)(20). Reported cases were classified into four categories: definite acute pancreatitis, possible acute pancreatitis, chronic pancreatitis, or unlikely to be pancreatitis.…”

Section: Methodsmentioning

confidence: 99%

Incidence of Pancreatitis and Pancreatic Cancer in a Randomized Controlled Multicenter Trial (SAVOR-TIMI 53) of the Dipeptidyl Peptidase-4 Inhibitor Saxagliptin

et al. 2014

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OBJECTIVETo determine the incidence of pancreatitis and pancreatic cancer in the SAVOR-TIMI 53 trial. RESEARCH DESIGN AND METHODSA total of 16,492 type 2 diabetic patients ‡40 years old with established cardiovascular (CV) disease or CV risk factors were randomized to saxagliptin or placebo and followed for 2.1 years. Outcome measures were investigator reported with blinded expert adjudication of total pancreatitis (acute and chronic) and reported cases of pancreatic cancer. No differences in time to event onset, concomitant risk factors for pancreatitis, investigatorreported causality from study medication or disease severity, and outcome were found between treatment arms. The investigators reported 5 and 12 cases of pancreatic cancer in the saxagliptin and placebo arms, respectively ], P = 0.09). RESULTS Trial investigators reported CONCLUSIONSIn the SAVOR-TIMI 53 trial, within 2.1 years of follow-up, risk for pancreatitis in type 2 diabetic patients treated with saxagliptin was low and apparently similar to placebo, with no sign of increased risk for pancreatic cancer. Further studies are needed to completely resolve the pancreatic safety issues with incretin-based therapy.

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Section: Methodsmentioning

confidence: 99%

Incidence of Pancreatitis and Pancreatic Cancer in a Randomized Controlled Multicenter Trial (SAVOR-TIMI 53) of the Dipeptidyl Peptidase-4 Inhibitor Saxagliptin

et al. 2014

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“…It is now defined as an encapsulated collection of fluid with a well-defined inflammatory wall usually outside the pancreas with minimal or no necrosis [33]. And, it is only defined when it has been present for a least 4 weeks after the onset of interstitial oedematous pancreatitis.…”

Section: Surgical Treatment Of Pseudocystmentioning

confidence: 99%

Surgery for Acute Pancreatitis

2015

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Surgery for acute pancreatitis has undergone significant changes over the last 3 decades. A better understanding of the pathophysiology has contributed to this, but the greatest driver for change has been the rise of less invasive interventions in the fields of laparoscopy, endoscopy and radiology. Surgery has a very limited role in the diagnosis of acute pancreatitis. The most common indication for intervention in acute pancreatitis is for the treatment of complications and most notably the treatment of infected walled off necrosis. Here, the step-up approach has become established, with prior drainage (either endoscopic or percutaneous) followed by delay for maturing of the wall and then debridement by endoscopic or minimally invasive surgical methods. Open surgery is only indicated when this approach fails. Other indications for surgery in acute pancreatitis are for the treatment of acute compartment syndrome, nono c c l u s i v e i n t e s t i n a l i s c h a e m i a a n d n e c r o s i s , enterocutaneous fistulae, vascular complications and pseudocyst. Surgery also has a role in the prevention of recurrent acute pancreatitis by cholecystectomy. Despite the more restricted role, surgeons have an important contribution to make in the multidisciplinary care of patients with complicated acute pancreatitis.

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“…The clinical outcome of interest was SAP. Acute severe pancreatitis is defined based on the presence of organ failure (Atlanta classification) or persistence of organ failure for more than 48 hours (revised Atlanta classification) [13,14]. …”

Section: Introductionmentioning

confidence: 99%

The Bedside Index for Severity in Acute Pancreatitis: a systematic review of prospective studies to determine predictive performance

Chandra

Murali

Bansal

et al. 2017

Journal of Community Hospital Internal Medicine Perspectives

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Background: predicting the development of severe disease has remained a major challenge in management of acute pancreatitis. The Bedside Index for Severity in Acute Pancreatitis (BISAP) is easy to calculate from the data available in the first 24 hours. Here, we performed a systematic review to determine the prognostic accuracy of the BISAP for severe acute pancreatitis (SAP). Methods: major databases of biomedical publications were searched during the first week of October 2015. Two independent reviewers searched records in two phases. Studies that reported prognostic accuracy of the BISAP for SAP from prospective cohorts were included. The pooled area under the receiver operating curve (AUC) was calculated. Results: Twelve studies were included for data-synthesis and methodology quality assessment was performed for 10. All the studies had enrolled consecutive patients, had a broad spectrum of the disease severity, reported explicit interpretation of the predictor, outcome of interest was well defined and had adequate follow-up. Blinded outcome assessment was reported in only one study. The pooled AUC was 0.85 (95% CI 0.80–0.90). There was significant heterogeneity, I 2 86.6%. Studies using revised Atlanta classification in defining SAP had a pooled AUC of 0.92 (95% CI, 0.90–0.95), but heterogeneity persisted, I 2 67%. Subgroup analysis based on rate of SAP (>20% vs <20%) did not eliminate the heterogeneity. Conclusion: the BISAP has very good predictive performance for SAP across different patient population and etiologies. Studies to evaluate the impact of incorporating the BISAP into clinical practice to improve outcome in acute pancreatitis are needed before adoption could be advocated with confidence.

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Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus

Abstract: Background and objective The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians.

Cited by 5,522 publications

References 67 publications

Incidence of Pancreatitis and Pancreatic Cancer in a Randomized Controlled Multicenter Trial (SAVOR-TIMI 53) of the Dipeptidyl Peptidase-4 Inhibitor Saxagliptin

Incidence of Pancreatitis and Pancreatic Cancer in a Randomized Controlled Multicenter Trial (SAVOR-TIMI 53) of the Dipeptidyl Peptidase-4 Inhibitor Saxagliptin

Surgery for Acute Pancreatitis

The Bedside Index for Severity in Acute Pancreatitis: a systematic review of prospective studies to determine predictive performance

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