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Table 3 Recommendations for the diagnosis of acute pancreatitis in the included guidelines (2014–2020)

From: Appraisal of the diagnostic procedures of acute pancreatitis in the guidelines

Guideline Reference Standard Ar [2] Li [3] Jo [4] Ma [5] AI [6] GS [7] PD [8]
(1) Primary diagnosis of AP
Symptoms and signs Abdominal pain (acute onset of a persistent, severe, epigastric pain often radiating to the back)
Biochemical evidence Serum lipase activity (or amylase) at least 3 times greater than the upper limit of normal
Urinary trypsinogen-2 dipstick     О    
Characteristic findings from abdominal imaging Characteristic findings of acute pancreatitis on ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI)
(2) Classification of the severity of AP
Classification tools Revised Atlanta Classification
Determinant-based Classification
JPN Severity Score
Prognostic factors C-reactive protein (CRP) level ≥ 150 mg/l
Urea > 20 mg/dl
CT Severity Index
Bedside index of severity of acute pancreatitis (BISAP) score
Acute Physiology and Chronic Health Evaluation II (APACHE-II) score
(3) Etiological diagnosis of AP
  Ultrasound (US) / endoscopic ultrasound (EUS)
Contrast-enhanced computed tomography (CECT)
Magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP)
Endoscopic retrograde cholangiopancreatography (ERCP)
Serum triglyceride levels ≥11.3mmol/L
Genetic testing
(4) Diagnosis of comorbidities of AP
contrast-enhanced MRI
Pancreatic necrosis/abdominal fluid collection/pseudocyst / walled-off necrosis (WoN) Fine needle aspiration (FNA)
Infected collection, necrosis or WoN MRCP
pancreatic fistula sustained intra-abdominal pressure (IAP) > 20 mmHg
Abdominal compartment syndrome (ACS) CECT
Vascular complications Hematocrit > 44%
Risk factors of pancreatic necrosis Procalcitonin
  Calcium levels
  1. О urinary trypsinogen-2 dipstick may be useful for minimally invasive method and rapid diagnosis of acute pancreatitis. However, this is not commercially available in Japan and therefore it cannot be recommended in the guideline
  2. Black circle indicates being recommended definitely; gray circle indicates being mentioned; en dash indicates being not mentioned
  3. APACHE-II Acute Physiology and Chronic Health Evaluation II score