Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus
- Peter A Banks1,
- Thomas L Bollen2,
- Christos Dervenis3,
- Hein G Gooszen4,
- Colin D Johnson5,
- Michael G Sarr6,
- Gregory G Tsiotos7,
- Santhi Swaroop Vege8,
- Acute Pancreatitis Classification Working Group
- 1Division of Gastroenterology, Hepatology, and Endoscopy, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
- 2Department of Radiology, St Antonius Hospital, Nieuwegein, the Netherlands
- 3First Department of Surgery, Agia Olga Hospital, Athens, Greece
- 4Evidence-Based Surgery Research Unit, University of Nijmegen, Nijmegen, the Netherlands
- 5University Hospital Southampton, Southampton, UK
- 6Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
- 7Division of Digestive Surgery, Metropolitan Hospital, Athens, Greece
- 8Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
- Correspondence to Michael G Sarr, Department of Surgery, Mayo Clinic (GU 10-01), 200 1st St SW, Rochester, MN 55905, USA;
- Revised 29 August 2012
- Accepted 29 August 2012
- Published Online First 25 October 2012
Background and objective The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary.
Methods A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations. This working draft was forwarded to all members. Revisions were made in response to comments, and the web-based consultation was repeated three times. The final consensus was reviewed, and only statements based on published evidence were retained.
Results The revised classification of acute pancreatitis identified two phases of the disease: early and late. Severity is classified as mild, moderate or severe. Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week. Moderately severe acute pancreatitis is defined by the presence of transient organ failure, local complications or exacerbation of co-morbid disease. Severe acute pancreatitis is defined by persistent organ failure, that is, organ failure >48 h. Local complications are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (sterile or infected), pseudocyst and walled-off necrosis (sterile or infected). We present a standardised template for reporting CT images.
Conclusions This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria. The wide consultation among pancreatologists to reach this consensus should encourage widespread adoption.