Published online Oct 28, 2020. doi: 10.3748/wjg.v26.i40.6270
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
Processing time: 132 Days and 11.5 Hours
Since the rapid progression of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, numerous publications postulated pancreatic involvement. Furthermore, angiotensin-converting enzyme 2 expression -the cellular entry point of the virus- was described in the pancreas.
Multiple etiological factors can be uncovered in a large proportion of acute pancreatitis cases. Therefore, the characterization of SARS-CoV-2 infection as a potential contributing factor was necessary.
Our aim was to review all available clinical evidence on acute pancreatitis cases in coronavirus disease 2019 (COVID-19) patients and to analyze the role of COVID-19 as an etiological factor.
A systematic search was conducted in five databases on 14 May 2020 (registration number CRD42020186426). Record selection and data extraction were carried out by two independent review authors. Studies containing the original data of at least 1 SARS-CoV-2-infected individual diagnosed with acute pancreatitis were considered eligible. The Joanna Briggs Institute Critical Appraisal Checklist for Case Reports and the Newcastle–Ottawa Scale were used for risk of bias assessment.
Eight studies (six case reports and two retrospective cohort studies) were included in this systematic review. All acute pancreatitis cases lacked proper etiological workup, but SARS-CoV-2 infection was confirmed by polymerase chain reaction in all cases. High risk of bias and non-compliance with the Case Report guideline was noted in all case reports.
Guideline adherence is a quality indicator of patient care. We advise all clinicians to conduct proper etiological workup before entertaining the possibility of SARS-CoV-2 as a causative agent of acute pancreatitis.
The potential mechanisms of pancreatic damage in COVID-19 should be investigated utilizing basic research methods and animal models to evaluate a possible causative association between SARS-CoV-2 and AP.