Acute pancreatitis: value of CT in establishing prognosis.
TL;DR: A CT severity index, based on a combination of peripancreatic inflammation, phlegmon, and degree of pancreatic necrosis as seen at initial CT study, was developed and showed clear trends in patients who initially had or developed more than 30% necrosis.
Abstract: The presence and degree of pancreatic necrosis (30%, 50%, or greater than 50%) was evaluated by means of bolus injection of contrast material and dynamic sequential computed tomography (CT) in 88 patients with acute pancreatitis at initial and follow-up examinations. Pancreatic necrosis was defined as lack of enhancement of all or a portion of the gland. Length of hospitalization, morbidity, and mortality in patients with early or late necrosis (22 patients) were evaluated and compared with the same criteria in the rest of the group. Patients with necrosis had a 23% mortality and an 82% complication rate; patients without necrosis had 0% mortality and 6% morbidity. When only the initial assessment was considered, patients with peripancreatic phlegmons and necrosis had 80% morbidity, compared with 36% morbidity in those with phlegmons and no necrosis. Serious complications occurred in patients who initially had or developed more than 30% necrosis. A CT severity index, based on a combination of peripancreatic inflammation, phlegmon, and degree of pancreatic necrosis as seen at initial CT study, was developed. Patients with a high CT severity index had 92% morbidity and 17% mortality; patients with a low CT severity index had 2% morbidity, and none died.
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TL;DR: This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria and should encourage widespread adoption.
Abstract: 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.
3,415 citations
TL;DR: In the absence of accepted definitions for acute pancreatitis and its complications, it has not been possible to devise a clinical classification system useful for case management as discussed by the authors, which is why a group of 40 international authorities from six medical disciplines and 15 countries participated in a three-day meeting and open discussion.
Abstract: • Acute pancreatitis is a protean disease capable of wide clinical variation, ranging from mild discomfort to apocalyptic prostration. Moreover, the inflammatory process may remain localized in the pancreas, spread to regional tissues, or even involve remote organ systems. This variability in presentation and clinical course has plagued the study and management of acute pancreatitis since its original clinical description. In the absence of accepted definitions for acute pancreatitis and its complications, it has not been possible to devise a clinical classification system useful for case management. Following 3 days of group meetings and open discussions, unanimous consensus on a series of definitions and a clinically based classification system for acute pancreatitis was achieved by a diverse group of 40 international authorities from six medical disciplines and 15 countries. The proposed classification system will be of value to practicing clinicians in the care of individual patients and to academicians seeking to compare interinstitutional data. (Arch Surg.1993;128:586-590)
2,521 citations
TL;DR: As the diagnosis of AP is most often established by clinical symptoms and laboratory testing, contrast-enhanced computed tomography and/or magnetic resonance imaging of the pancreas should be reserved for patients in whom the diagnosis is unclear or who fail to improve clinically.
1,657 citations
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TL;DR: There is a wide spectrum of disease from mild (80%), where patients recover within a few days, to severe (20%) with prolonged hospital stay, the need for critical care support, and a 15-20% risk of death.
Abstract: Acute pancreatitis is inflammation of the pancreas; it is sometimes associated with a systemic inflammatory response that can impair the function of other organs or systems. The inflammation may settle spontaneously or may progress to necrosis of the pancreas or surrounding fatty tissue. The distant organ or system dysfunction may resolve or may progress to organ failure. Thus there is a wide spectrum of disease from mild (80%), where patients recover within a few days, to severe (20%) with prolonged hospital stay, the need for critical care support, and a 15-20% risk of death. If patients have organ failure during the first week in hospital, it is usually already present on the first day in hospital. This early organ failure may resolve in response to treatment. The diagnosis of severe acute pancreatitis depends on the presence of persistent organ failure (>48 hours) either during the first week or at a later stage, and also on the presence of local complications (usually apparent after the first week).
1,399 citations
TL;DR: The 2012 IAP/APA guidelines provide recommendations concerning key aspects of medical and surgical management of acute pancreatitis based on the currently available evidence that should serve as a reference standard for current management and guide future clinical research on acute Pancreatitis.
1,396 citations
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...using the CT severity index (CTSI) criteria [28], should be performed only thereafter....
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