Schneider et al report the M-ANNHEIM system for evaluating a patient with chronic pancreatitis. Clinical staging is a modification of the method reported by Chari and Singer. The system was developed at the the University of Heidelberg in Mannheim, Germany.
Patient selection: chronic pancreatitis
Parameters:
(1) asymptomatic vs symptomatic
(2) number of episodes
(3) pancreatic function
(4) severe complications (reversible complications: ascites, bleeding, pseudoaneurysm, obstruction or stricture of ductus choledochus, pancreatic fistula, duodenal stenosis; irreversible complications: portal or splenic vein thrombosis, pancreatic cancer)
Clinical Status
|
Stage
|
asymptomatic, subclinical
|
0
|
symptomatic, without pancreatic insufficiency
|
I
|
symptomatic with partial pancreatic insufficiency
|
II
|
symptomatic with painful complete pancreatic insufficiency
|
III
|
burnout with secondary painless disease
|
IV
|
Subclasses for Stage 0:
0a: found incidentally
0b: single episode of acute pancreatitis
0c: acute pancreatitis with severe complications
Subclasses of Stage I:
Ia: recurrent acute pancreatitis without pain between episodes
Ib: recurrent and/or chronic abdominal pain with or without pain between episodes
Ic: Ia or Ib AND severe complications
Subclasses of Stage II:
IIa: isolated endocrine or exocrine insufficiency without pain
IIb: isolated endocrine or exocrine insufficiency with pain
IIc: IIa or IIb AND severe complications
Subclasses of Stage III:
IIIa: exocrine and endocrine insufficiency with pain
IIIb: IIIa AND severe complications
Subclasses of Stage IV:
IVa: exocrine and endocrine insufficiency without pain AND without severe complications
IVb: exocrine and endocrine insufficiency without pain AND with severe complications