Post-pancreaticoduodenectomy, a patient develops a post-operative pancreatic fistula (POPF). Drain amylase on day 3 is 4500 U/L (>3x upper limit). The patient is well with no fever or peritonitis. According to the International Study Group of Pancreatic Surgery (ISGPS) classification, what grade is this POPF?
- A Grade B — requires change in management (prolong drainage, octreotide, or IR drain)
- B Grade C — requires re-operation or is life-threatening
- C Not classified as POPF unless imaging confirms pancreatic duct disruption
- D Grade A (biochemical leak) — no clinical impact, continue conservative management ✓
Explanation
The 2016 ISGPS updated classification: Grade A (formerly 'biochemical leak') is defined as elevated drain amylase > 3x serum upper limit on or after day 3, with no clinical impact and no change in management — patient follows normal postoperative course. Grade B requires a change in clinical management (prolonged drain, octreotide, antibiotics, IR drainage). Grade C is a clinically severe POPF requiring re-operation, organ failure, or death. Given the patient is well with no clinical consequence, this is Grade A biochemical leak, which does not affect outcomes and drains can be removed early.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.