“Based on the literature since 2005 investigating the validity and clinical use of the original
International Study Group of Pancreatic Fistula classification, a clinically relevant postoperative pancreatic fistula is now redefined as a drain output of any measurable volume of fluid with an amylase level >3 times the upper limit of institutional normal serum amylase activity, associated with a clinically relevant development/condition related directly to the postoperative pancreatic fistula. Consequently, the former “grade A postoperative pancreatic fistula” is now redefined and called a “biochemical leak,” because it has no clinical importance and is no longer referred to a true pancreatic fistula. Postoperative pancreatic fistula grades B and C are confirmed but defined more strictly. In particular, grade B requires a change in the postoperative management; drains are either left in place >3 weeks or repositioned through endoscopic or percutaneous procedures. Grade C postoperative pancreatic fistula refers to those postoperative pancreatic fistula that require eoperation or lead to single or multiple organ failure and/or mortality attributable to the pancreatic fistula.”

“The conclusions of the 2005 ISGPF publication suggested that the use of the proposed classification of POPF would confirm its clinical value and allow accurate comparison across different surgical practices internationally. Indeed, 11 years later, the ISGPS has re-valuated the impact of this original classification and can attest that the original goals in creating the classification have been reached.
We now speak a common language for many aspects of pancreatic operation, and POPF has become a standardized definition in our clinical lexicon. The number of citations of the original 2005 ISGPF article (n = 1,707) and the almost universal acceptance of the definition and classification of POPF reinforces this concept. The use of the ISGPF classifications have provided the ability to better assess the efficacy of numerous operative approaches and mitigation strategies, and analyse surgical performance.”

Bassi, Claudio et al. “The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After.” Surgery vol. 161,3 (2017): 584-591. Full Text for Emory Users