The Acceptance of Changes in the Management of Patients With Acute Pancreatitis After the Revised Atlanta Classification

Abstract

BACKGROUND: New recommendations for the management of patients with acute pancreatitis were set after the Atlanta Classification was revised in 2012. OBJECTIVE: The aim of the present systematic review is to assess whether these recommendations have already been accepted and implemented in daily medical practices. METHODS: A systematic literature review was carried out in studies conducted with humans and published in English and Portuguese language from 10/25/2012 to 11/30/2018. The search was conducted in databases such as PubMed/Medline, Cochrane and SciELO, based on the following descriptors/Boolean operator: “Acute pancreatitis” AND “Atlanta”. Only Randomized Clinical Trials comprising some recommendations released after the revised Atlanta Classification in 2012 were included in the study. RESULTS: Eighty-nine studies were selected and considered valid after inclusion, exclusion and qualitative evaluation criteria application. These studies were stratified as to whether, or not, they applied the recommendations suggested after the Atlanta Classification revision. Based on the results, 68.5% of the studies applied the recommendations, with emphasis on the application of severity classification (mild, moderately severe, severe); 16.4% of them were North-American and 14.7% were Chinese. The remaining 31.5% just focused on comparing or validating the severity classification. CONCLUSION: Few studies have disclosed any form of acceptance or practice of these recommendations, despite the US and Chinese efforts. The lack of incorporation of these recommendations didn’t enable harnessing the benefits of their application in the clinical practice (particularly the improvement of the communication among health professionals and directly association with the worst prognoses); thus, it is necessary mobilizing the international medical community in order to change this scenario.

Diagnóstico e classificação em Pancreatite Aguda

“…A pancreatite aguda (PA), consiste em um processo inflamatório agudo que afeta o tecido pancreático, com envolvimento variável de outros tecidos regionais ou sistemas de órgãos remotos. Mesmo possuindo apresentações leves, a enfermidade é potencialmente grave e é capaz de evoluir com lesão peripancreática, síndrome da resposta inflamatória sistêmica (SIRS) e falência de múltiplos órgãos (Alves et al, 2021;da Silva, 2018;Okabayashi, Casaca, Rodrigues, & Martins, 2020;de Sousa Carneiro et al, 2021;Duarte et al, 2019).…”

“…No Ocidente, a incidência da inflamação é de aproximadamente 10 a 20 indivíduos por cada 100 mil habitantes ao ano. Na maioria dos casos, a PA tem início rápido, associada com dor súbita nos quadrantes superiores do abdômen e achados no exame físico abdominal, como sensibilidade à manipulação e ausência de sons auscultatórios (Bradley, 1993;Kumar, Abbas, & Aster, 2018;Townsend, Beuchamp, Evers, Mattox, 2019;Alves, Ferrazza, Nunes Junior, & Teive, 2021;da Silva, 2018). De acordo com a análise estatística de Perry et al (2015) A PA ocupou o décimo quinto lugar das causas de morte por doenças gastrointestinais, hepáticas e pancreáticas nos Estados Unidos em 2012.…”

Differential Diagnosis Between Biliary and Nonbiliary Acute Pancreatitis: What Is the Importance of Laboratory Tests?

“…Patients whose data did not include the measurement of serum lipase or did not have a value of at least three times the upper limit of normality, considering the test that confirms in laboratory the diagnosis of AP more specifically, were excluded from the study 1 , 4 , 8 , 9 , 16 , 25 , 29 , 30 .…”

“…suggestive findings on imaging examinations, such as contrast-enhanced CT and/or abdominal ultrasound 1 , 4 , 8 , 9 , 16 , 29 , 30 .…”

“…The first widely used AP severity scale dates back to 1974, with the publication of the Ranson Criteria (modified in 1982), which can estimate the morbidity and mortality related to the condition 7,20 . Although several other scores have been proposed and some authors still consider the Ranson Criteria to be limited, especially since they require 48 h to be defined 1 , 2 , 16 , they are still widely used owing to their easy application and specificity in determining the prognosis of the disease 24 .…”