TOWARDS AN UPDATE OF THE ATLANTA CLASSIFICATION ON ACUTE PANCREATITIS

Abstract

Objectives: The 1992 Atlanta symposium abandoned several terms that were used at that time to define the severity and complications of acute pancreatitis. The purpose of this review was to assess whether these terms are really discarded in the literature. The second objective was to review new terms that have appeared in the literature since the Atlanta symposium. Methods: A Medline search was conducted to identify reviews and guidelines on acute pancreatitis and its complications, published since the Atlanta classification: "review OR guidelines AND acute pancreatitis". For identification of articles regarding the abandoned terms a search strategy was followed that included the following terms: 'phlegmon'; 'infected pseudocyst'; 'hemorrhagic pancreatitis'; and 'persistent pancreatitis'. We also searched the Medline database for new terms introduced after the publication of the Atlanta classification. Results: A total of 239 studies were reviewed, including 10 guideline articles and 42 reviews. 'Hemorrhagic pancreatitis' and 'persistent acute pancreatitis' were hardly encountered in the literature since the Atlanta classification. In contrast, both 'infected pseudocyst' and 'phlegmon' were frequently used and several authors criticized the fact that these terms were abandoned by the Atlanta symposium. New terms that were frequently found in the literature were 'organized pancreatic necrosis,' 'necroma', 'extrapancreatic necrosis' and 'central gland necrosis'. Conclusion: Several terms abandoned by the Atlanta symposium are still used frequently in the literature. Moreover, new terms have been introduced. This implies that the Atlanta definitions are not universally accepted and revision of the Atlanta classification may be required.