The Risk Factors for Moderately Severe and Severe Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis According to the Revised Atlanta Classification

OBJECTIVES The aim of this study was to confirm the value of the revised Atlanta classification for predicting the severity of post-endoscopic retrograde choloangiopancreatography pancreatitis (PEP) and to validate the risk factors for moderately severe and severe PEP. METHODS Among 2672 patients, 86 with PEP and 172 randomly selected control patients were included in this study. Post-endoscopic retrograde choloangiopancreatography pancreatitis was evaluated according to Cotton criteria and the revised Atlanta classification. The agreements between the 2 sets of criteria were compared, and the risk factors for moderately severe and severe PEP were identified. RESULTS According to the revised Atlanta classification, 72 patients (83.7%) had mild, 11 (12.8%) had moderately severe, and 3 (3.5%) had severe disease. The agreement between the revised Atlanta classification and Cotton criteria was fair (κ = 0.285). Statistically significant risk factors for PEP were difficult cannulation and dye injection in the pancreatic duct, including acinarization. For moderately severe or severe PEP, obesity (hazard ratio, 3.384 [95% confidence interval, 1.023-11.191]) was the only statistically significant risk factor. CONCLUSIONS The revised Atlanta classification of acute pancreatitis is an effective and feasible classification system for predicting PEP severity. Obesity was identified as an important risk factor predicting moderately severe and severe PEP.