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Toward an Update of the Atlanta Classification on Acute Pancreatitis: Review of New and Abandoned Terms

Bollen, Thomas L MD*; Besselink, Marc G.H. MD; van Santvoort, Hjalmar C MD; Gooszen, Hein G MD, PhD; van Leeuwen, Maarten S MD, PhD

doi: 10.1097/mpa.0b013e31804fa189

Objectives: The 1992 Atlanta classification is a clinically based classification system that defines the severity and complications of acute pancreatitis. The purpose of this review was to assess whether the terms abandoned by the Atlanta classification are really discarded in the literature. The second objective was to review what new terms have appeared in the literature since the Atlanta symposium.

Methods: We followed a Medline search strategy in review and guideline articles after the publication of the Atlanta classification. This search included the abandoned terms: "phlegmon," "infected pseudocyst," "hemorrhagic pancreatitis," and "persistent pancreatitis."

Results: A total of 239 publications were reviewed, including 10 guideline articles and 42 reviews. The abandoned terms "hemorrhagic pancreatitis" and "persistent pancreatitis" are hardly encountered, in contrast, both "infected pseudocyst" and "phlegmon" are frequently used, and several authors question their abandonment. New terminology in acute pancreatitis consists of "organized pancreatic necrosis," "necroma," "extrapancreatic necrosis," and "central gland necrosis."

Conclusions: This review demonstrates that the Atlanta classification is still not universally accepted. Several abandoned terms are frequently used, and new terms have emerged that describe manifestations in acute pancreatitis that were not specifically addressed during the Atlanta symposium.

From the *Department of Radiology, St. Antonius Hospital, Nieuwegein; and †Departments of Surgery and ‡Radiology, University Medical Center Utrecht and Dutch Acute Pancreatitis Study Group, the Netherlands, Utrecht, The Netherlands.

Received for publication July 30, 2006; accepted February 20, 2007.

Reprints: Thomas L. Bollen, MD, Department of Radiology, St. Antonius Hospital, PO Box 2500, 3430 EM Nieuwegein, The Netherlands (e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.