Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2021; 13(6): 574-584
Published online Jun 27, 2021. doi: 10.4240/wjgs.v13.i6.574
Acute pancreatitis and COVID-19: A literature review
Tiago Correia de Sá, Carlos Soares, Mónica Rocha
Tiago Correia de Sá, Carlos Soares, Mónica Rocha, Department of General Surgery, Centro Hospitalar do Tâmega e Sousa, Penafiel 4564-007, Portugal
Author contributions: Correia de Sá T, Soares C, and Rocha M designed the research study and performed the research; Correia de Sá T analyzed the data and wrote the manuscript; All authors have read, reviewed, and approved the final manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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: Tiago Correia de Sá, MD, Surgeon, Department of General Surgery, Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, Penafiel 4564-007, Portugal. tiago.rc.sa@gmail.com
Received: January 10, 2021
Peer-review started: January 10, 2021
First decision: February 14, 2021
Revised: February 26, 2021
Accepted: June 1, 2021
Article in press: June 1, 2021
Published online: June 27, 2021
Abstract
BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the ongoing pandemic of coronavirus disease 2019 (COVID-19), and has caused more than 80 million infections and 1.7 million deaths worldwide. Although it is primarily a respiratory virus, SARS-CoV-2 also has extra-pulmonary effects. Pancreatic injury and cases of acute pancreatitis (AP) have been recognized and attributed to SARS-CoV-2, but the mechanisms of pancreatic injury are still a subject of debate. There is also controversy on whether SARS-CoV-2 can cause AP or if it is an epiphenomenon.

AIM

To review and to explore the relationship between SARS-CoV-2 infection and AP, and to provide an overview of the existing literature on possible mechanisms of SARS-CoV-2-induced pancreatic lesion.

METHODS

A systematic review was conducted in accordance with PRISMA guidelines for papers on SARS-CoV-2 infection and AP. A narrative review on possible mechanisms of SARS-CoV-2-induced pancreatic lesion was also performed.

RESULTS

A literature review revealed a growing body of evidence on SARS-CoV-2-induced pancreatic lesions including the mechanisms of direct virus-mediated injury, systemic inflammatory response and circulating pro-inflammatory interleukins, virus-induced lipotoxicity, and drug-induced injury. A systematic review of the literature revealed 22 cases of AP in COVID-19 patients. However, limitations of the reported cases make it difficult to establish a causal relationship between SARS-CoV-2 infection and AP. All of the studies agreed on special monitoring and surveillance of this subset of patients due to the still unknown clinical progression, therapeutic implications, and prognosis.

CONCLUSION

AP should be considered in COVID-19 patients, especially in those exhibiting abdominal pain and systematic, and complete reporting of these cases should be general practice. However, there is still insufficient evidence showing that COVID-19 can cause AP or negatively impact prognosis. Additional studies are needed to clarify the relationship between these two entities and their theragnostic significance.

Keywords: Pancreatitis, Pancreas, COVID-19, SARS-CoV-2

Core Tip: Recently, an association between acute pancreatitis (AP) and coronavirus disease 2019 (COVID-19) has been proposed, but the mechanisms of pancreatic injury of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are not fully understood. Although viral-induced AP is an established diagnosis, there is still insufficient evidence clearly showing COVID-19 as AP etiology. We conducted an in-depth analysis on the mechanisms of pancreatic injury by SARS-CoV-2 and reviewed published cases of AP in COVID-19 patients.