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Pancreatitis is among the most variable diseases known to us, and is the number 1 benign disorder leading to hospital admission.1 Its natural history ranges from complete recovery after a single episode, to chronic debilitating disease over decades, to rapid death. In acute pancreatitis, the problem of unpredictability is compounded because 80% of patients with mild pancreatitis require only short hospital admissions and little in terms of resources. The remaining 20% with severe pancreatitis will have to be triaged to either aggressive early treatment, transfer to intensive care, or referral to tertiary specialist centres. When evidence emerged that certain clinical and diagnostic imaging characteristics allow to distinguish mild from severe pancreatitis on hospital admission, severity classifications of pancreatitis were introduced. The earliest such efforts date back half a century,2 but a better understanding of the natural history and refinements in diagnostic tools required updates roughly every decade. The most widely accepted such systems were the Marseille classification of 19843 and the Atlanta classification of 1992.4 A revision of the Atlanta classification has now been accomplished and appears in this issue of Gut.5
The genesis of pancreatitis is interesting. Rather than withdrawing to a secluded but sunny location for a meeting of world experts, or using the established instruments of evidence-based medicine with their formalised literature search and consensus-finding tools, the authors have chosen a web-based consensus-building approach. They first considered required revisions to the original Atlanta classification, composed an initial draft, and distributed it through the email lists of 11 international pancreas societies. Their initial call for suggestions and corrections was answered by 40 respondents, the second call by 57 and the third by 58 more. When the draft was put on the internet, while falling short of going viral, it not only led …
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