Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2020; 26(40): 6270-6278
Published online Oct 28, 2020. doi: 10.3748/wjg.v26.i40.6270
Insufficient etiological workup of COVID-19-associated acute pancreatitis: A systematic review
Márk Félix Juhász, Klementina Ocskay, Szabolcs Kiss, Péter Hegyi, Andrea Párniczky
Márk Félix Juhász, Klementina Ocskay, Andrea Párniczky, Institute for Translational Medicine, University of Pécs, Medical School, Pécs 7624, Hungary
Szabolcs Kiss, Doctoral School of Clinical Medicine, University of Szeged, Szeged 6720, Hungary
Péter Hegyi, Institute for Translational Medicine, Medical School, University of Pécs, Pécs 7624, Hungary
Andrea Párniczky, Department of Pediatrics, Heim Pál National Institute for Pediatrics, Budapest 1089, Hungary
Author contributions: Juhász MF and Ocskay K contributed equally, as first authors, in the systematic search and selection, data extraction, writing, preparing tables and figures; Kiss S performed the risk of bias assessment and prepared one of the tables; Hegyi P provided critical insight for the focus and writing of the article; Párniczky A contributed to the design and coordinated the writing of the paper.
Supported by European Union (European Regional Development Fund), No. GINOP-2.3.2-15-2016-00048 and EFOP 3.6.2-16-2017-00006.
Conflict-of-interest statement: Authors declare no conflict of interest.
PRISMA 2009 Checklist statement: The guidelines of the PRISMA 2009 statement have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Andrea Párniczky, MD, PhD, Doctor, Research Fellow, Department of Pediatrics, Heim Pál National Institute for Pediatrics, Üllői Street 86, Budapest 1089, Hungary. andrea.parniczky@gmail.com
Received: June 17, 2020
Peer-review started: June 17, 2020
First decision: July 28, 2020
Revised: August 11, 2020
Accepted: September 23, 2020
Article in press: September 23, 2020
Published online: October 28, 2020
Abstract
BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, mostly causing respiratory symptoms, is also known to affect the gastrointestinal tract. Several case reports hypothesize that SARS-CoV-2 could be an etiological factor in acute pancreatitis (AP).

AIM

To assess all the available evidence in the literature relating to coronavirus disease 2019 (COVID-19) and AP.

METHODS

We performed a systematic review of the available literature on the topic. The systematic search was conducted on 15 May 2020 on MEDLINE, EMBASE, CENTRAL, Web of Science and Scopus with a search key using the terms “amylase,” “lipase,” “pancr*,” “COVID-19” and synonyms. Due to the low quality and poor comparability of the studies, a meta-analysis was not performed.

RESULTS

Six case reports and two retrospective cohorts were included, containing data on eleven COVID-19 patients with AP. Five patients had AP according to the Atlanta classification. Other publications did not provide sufficient information on the diagnostic criteria. Most cases were considered SARS-CoV-2-induced, while several established etiological factors were not investigated. We were able to identify other possible causes in most of them.

CONCLUSION

We strongly highlight the need for adherence to the guidelines during a diagnostic and etiological workup, which could alter therapy.

Keywords: Pancreas, COVID-19, Pancreatic involvement, Pancreatitis, Amylase, Lipase

Core Tip: As the severe acute respiratory syndrome coronavirus 2 pandemic spreads, numerous coronavirus disease 2019 patients will be diagnosed with acute pancreatitis (AP). Viral infections are known etiological factors of AP, but taking a look at the available literature several shortcomings of the diagnostic end etiological workups were uncovered, therefore the causative relationship between coronavirus disease 2019 and AP cannot be established. We highlight the fundamental role of guideline adherence in the diagnosis and etiological workup of AP since etiology-specific therapeutic options are available. Identifying underlying etiological factors is the foundation of high-quality patient care in AP.