# Revised Atlanta — Revised Atlanta classification of acute pancreatitis

> Time-dependent acute-pancreatitis framework separating the clinical three-grade severity axis from interstitial versus necrotizing morphology and four collection types. Diagnosis requires two of three clinical, laboratory or imaging criteria; organ-failure duration must be reassessed before severity is finalized, and the classification itself is not a treatment guideline.

**Situação:** vigente · **Órgão:** Pâncreas · **Órgão emissor:** Acute Pancreatitis Classification Working Group · **Versão:** 2012 consensus (published 2013); 2024 ACG care context · **Ano:** 2013

> ⚠️ Uma versão mais nova pode existir (em revisão).

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: CT, MRI, US
- Fonte primária: Banks PA, Bollen TL, Dervenis C, et al.. Classification of acute pancreatitis 2012: revision of the Atlanta classification and definitions by international consensus (2013) — https://naspghan.org/files/documents/pdfs/training/curriculum-resources/pancreatic-disease/Banks_Classification_of_acute_pancreatitis-2012_revision_of_the_Atlantal_classification_and_definitions_by_international_consensus.pdf
- Última verificação: 2026-07-24
- Última checagem: 2026-08-12

## Lógica de decisão
Confirm acute pancreatitis with the two-of-three gate, classify clinical severity dynamically from organ failure and complications, and report morphology on independent axes. The consensus standardizes definitions and does not itself prescribe treatment.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| mild | Mild, no organ failure or complications | Confirmed acute pancreatitis with no modified-Marshall organ failure and no local or systemic complication. Diagnosis first requires at least two of three: characteristic acute epigastric pain, lipase or amylase at least three times the upper limit of normal, or characteristic CT, MRI or ultrasound findings. Time the episode from pain onset, not admission, and report morphology separately. | The Revised Atlanta consensus defines this category but is not a treatment guideline. In current ACG context, begin a low-fat solid oral diet within 24-48 hours as tolerated, use individualized early monitoring and lactated-Ringer-based fluid care, avoid prophylactic antibiotics, and investigate etiology. Do not obtain admission CT solely to prove pancreatitis when pain and enzymes already satisfy the diagnostic gate. | This is the most favorable consensus category and mortality is described as rare. That statement is population-level rather than a zero-risk guarantee; etiology, age, comorbidity, hemodynamics and subsequent evolution remain important, and a later complication or organ failure can increase the recorded maximum severity. | Banks et al. Gut 2013, DOI 10.1136/gutjnl-2012-302779, Diagnosis of acute pancreatitis, Definition of onset and Grades of severity; Tenner et al. ACG 2024, DOI 10.14309/ajg.0000000000002645, official highlights for early oral feeding, fluids, antibiotics and CT timing. | ✓ |
| moderately-severe | Moderately severe | Confirmed acute pancreatitis with transient organ failure resolving in less than 48 hours and/or at least one local or systemic complication, but without persistent organ failure beyond 48 hours. Organ failure is a modified Marshall score of at least 2 in the respiratory, cardiovascular or renal system. Name every complication and separately classify interstitial versus necrotizing morphology and each collection as APFC, pseudocyst, ANC or WON. | Provide close clinical and organ-function reassessment, including the 48-hour duration boundary, and treat the actual complication rather than the label. Current ACG context favors enteral nutrition when oral intake is not tolerated, avoids parenteral nutrition when feasible and reserves CT or MRI for diagnostic uncertainty or failure to improve at 48-72 hours. Cholangitis, infected necrosis, obstruction or symptomatic collections follow their own clinical pathways. | Morbidity and mortality are higher than in mild disease but lower than in severe disease at the population level; the code supplies no calibrated individual probability. A patient with a local complication but no organ failure and one with transient organ failure share the category but not necessarily the same course, so retain the qualifying features and serial physiology. | Banks et al. 2013 consensus, Definitions of organ failure, local/systemic complications and moderately severe acute pancreatitis; morphological sections for APFC, pseudocyst, ANC and WON; Tenner et al. 2024 official ACG highlights for imaging, enteral nutrition and complication-led care. | ✓ |
| severe | Severe, persistent organ failure | Confirmed acute pancreatitis with persistent organ failure continuing for more than 48 hours in one or more modified-Marshall systems, whether or not local or systemic complications are present. Before that duration is known, report potentially severe or provisional severity and reassess rather than prematurely finalizing moderate versus severe. Preserve organ-specific scores and timestamps. | Escalate organ-support and multidisciplinary care according to physiology, not the adjective alone. Use enteral feeding when feasible, evaluate suspected infection without prophylactic antibiotics, perform urgent ERCP when concomitant cholangitis provides the indication, and in a stable patient delay intervention for pancreatic necrosis approximately 4-6 weeks when clinically feasible. Hemodynamic instability, infection and other complications can require earlier action independent of collection maturity. | Persistent organ failure is the highest-risk Atlanta category. The original consensus cited approximately 36-50 percent mortality for early persistent organ failure in historical cohorts, but this is not a current bedside probability or treatment threshold. Risk varies with the number of failed organs, trajectory, infection, age, comorbidity and quality of supportive care. | Banks et al. 2013 consensus, persistent organ failure and severe acute pancreatitis definitions plus historical early-phase mortality context; Tenner et al. 2024 ACG official highlights for organ-support setting, enteral nutrition, infection, cholangitis-associated ERCP and delayed stable-necrosis intervention. | ✓ |

### Citações por categoria
- **mild**: Banks PA, Bollen TL, Dervenis C, et al.. Classification of acute pancreatitis 2012: revision of the Atlanta classification and definitions by international consensus (2013) — https://naspghan.org/files/documents/pdfs/training/curriculum-resources/pancreatic-disease/Banks_Classification_of_acute_pancreatitis-2012_revision_of_the_Atlantal_classification_and_definitions_by_international_consensus.pdf · Banks et al. Gut 2013, DOI 10.1136/gutjnl-2012-302779, Diagnosis of acute pancreatitis, Definition of onset and Grades of severity; Tenner et al. ACG 2024, DOI 10.14309/ajg.0000000000002645, official highlights for early oral feeding, fluids, antibiotics and CT timing.
- **moderately-severe**: Banks PA, Bollen TL, Dervenis C, et al.. Classification of acute pancreatitis 2012: revision of the Atlanta classification and definitions by international consensus (2013) — https://naspghan.org/files/documents/pdfs/training/curriculum-resources/pancreatic-disease/Banks_Classification_of_acute_pancreatitis-2012_revision_of_the_Atlantal_classification_and_definitions_by_international_consensus.pdf · Banks et al. 2013 consensus, Definitions of organ failure, local/systemic complications and moderately severe acute pancreatitis; morphological sections for APFC, pseudocyst, ANC and WON; Tenner et al. 2024 official ACG highlights for imaging, enteral nutrition and complication-led care.
- **severe**: Banks PA, Bollen TL, Dervenis C, et al.. Classification of acute pancreatitis 2012: revision of the Atlanta classification and definitions by international consensus (2013) — https://naspghan.org/files/documents/pdfs/training/curriculum-resources/pancreatic-disease/Banks_Classification_of_acute_pancreatitis-2012_revision_of_the_Atlantal_classification_and_definitions_by_international_consensus.pdf · Banks et al. 2013 consensus, persistent organ failure and severe acute pancreatitis definitions plus historical early-phase mortality context; Tenner et al. 2024 ACG official highlights for organ-support setting, enteral nutrition, infection, cholangitis-associated ERCP and delayed stable-necrosis intervention.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2026-07-25 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2024-03-01 | revised | The ACG published current acute-pancreatitis management guidance used here as care context; it does not alter the Revised Atlanta severity codes or collection definitions. | confirmed |
| 2013-01-01 | revised | Revised Atlanta classification published. | confirmed |


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