The diagnosis and treatment of acute pancreatitis (AP), especially the treatment of severe acute pancreatitis (SAP), fully reflects the concept of multidisciplinary teams (MDT). The support from the Department of Critical Care Medicine is needed for organ function maintenance and fluid resuscitation, the support from the Department of Nutrition is needed for enteral nutrition, the timely intervention of surgeons is needed for complications such as abdominal hypertension and pancreatic abscess, the assistance of laparoscopic surgery is needed for gallbladder resection, the intervention of gastrointestinal endoscopists is needed for pancreatic pseudocysts and bile duct stones, the guidance of anti-infective physicians is needed for sepsis, the control of hyperglycemia and hyperlipidemia is needed, and the assistance of endocrinologists is needed. The mode of hemodialysis cannot be achieved without the guidance of a physician specializing in nephrology, pancreatitis during pregnancy requires the guidance of an obstetrician, and so on. Therefore, in a sense, the treatment of AP can no longer be done by a single discipline, but needs to reflect the concept of MDT, master multidisciplinary knowledge, establish MDT consultation system, and set up MDT treatment team in order to improve the success rate of treatment, which is also the MDT model advocated at home and abroad. Recently, experts in multidisciplinary fields were organized by the Pancreatology Special Committee of the Chinese Medical Association to develop the first domestic MDT Consensus Opinion on Acute Pancreatitis (Draft), which elaborates the diagnosis and treatment process of AP from a unique perspective, taking into account the latest research progress at home and abroad. This article focuses on the features of this consensus, and provides interpretation in unifying the classification criteria of AP, setting MDT recommendations, distinguishing the treatment priorities of different types of AP, and dealing with late complications, so as to help the understanding and promotion of this consensus. Unification of classification criteria for acute pancreatitis The classification of AP is a prerequisite for clinical diagnosis and treatment, and has attracted widespread attention since the Atlanta criteria were updated in 2013. According to incomplete statistics, the criteria have been cited 274 times by SCI so far, which has been widely recognized by the academic community. Although some scholars have recently proposed to classify AP with both infection and organ failure as “very critical pancreatitis”, this is also an improvement on the triple classification criteria and has not yet been promoted. Therefore, the current trichotomous criteria are the mainstream classification method, which classifies AP into three major categories: MAP, MSAP and SAP, but there are still some differences in the Chinese naming of specific categories. In the latest AP medical, surgical, emergency and combined Chinese and Western medicine guidelines in China, there is no objection to the names of mild AP (MAP) and severe AP (SAP), but the naming of MSAP is not yet uniform. The new MDT consensus, based on consultation with experts in internal medicine, surgery, and critical care medicine, suggests the name “moderate severe acute pancreatitis” for MSAP, which reflects that this type of AP is differentiated from the traditional SAP and is easier to understand. From the recent literature search in China, this designation is also used more frequently than “moderate acute pancreatitis”. Therefore, the new consensus unifies the classification criteria of AP into three major categories: mild, moderate severe and severe acute pancreatitis, which is conducive to the clinical diagnosis and treatment of AP and academic communication. For how to distinguish the three major categories of AP, the consensus suggests the presence or absence of local or systemic complications and the presence or absence of organ failure as the distinguishing points, of which the former is the distinguishing point between MAP and MSAP, and the latter is the distinguishing point between MSAP and SAP (lasting 48h). Besides, the consensus also proposed to distinguish different types of AP by symptoms and signs, laboratory tests, imaging tests and AP severity score, which is more clinically practical. The role of liver and kidney function, blood calcium, and serum calcitoninogen (PCT) are emphasized in laboratory tests. In imaging examinations, CT scan of the pancreas was emphasized as the preferred method to diagnose and judge the severity of AP. For the first time, it was clarified that the timing of CT examination should be completed within 12 h of emergency patient presentation for plain examination, but completion of enhanced CT examination after 72 h of onset could effectively differentiate the extent of peripancreatic fluid accumulation and pancreatic necrosis, and some scholars suggested that enhanced scan should be performed at 7-10 d of onset. The Ranson score is not applicable because it is old and requires dynamic observation, and the APACHE II score is reliable but complicated to calculate. In contrast, the BISAP score and modified CT score (MCTSI) contain fewer indicators and are easy to determine, and are recommended by the MDT consensus for clinical judgment of AP severity. PCO2 <32 mmHg, P >90 beats/min, WBC <4×109 or >12×109/L or naïve neutrophils >10%, at least 2 of which can be identified as SIRS); (4) age >60 years; (5) pleural effusion. There are 3 items in the modified CTSI: (1) 0 points for normal pancreatic morphology, 2 points for pancreatic and/or peripancreatic inflammatory changes, 4 points for single or multiple areas of fluid accumulation or peripancreatic fat necrosis; (2) 0 points for no pancreatic necrosis, 2 points for necrosis range ≤ 30%, 4 points for > 30%; (3) 0 points for no extra-pancreatic complications (3) no extra-pancreatic complications 0 points, concurrent pleural effusion, ascites, gastric outflow tract obstruction, pseudocystic hemorrhage, splenic vein or portal vein thrombosis, etc. 2 points. A total score ≥4 was considered for MASP or SAP. a Marshall score for organ failure was used to diagnose SAP (Table 1). Setting of multidisciplinary (MDT) recommendations As an MDT consensus, it is important to reflect the close collaboration between multiple disciplines, as well as to reflect the consultation and treatment process around the AP patient. For example, in the MDT recommendations for AP classification, it is stated that “the first consulting physician is very important in determining the severity of the disease, especially in the early identification of SAP, and it is recommended to complete all laboratory tests and CT scan of the pancreas as soon as possible, and to establish a multidisciplinary coordination, consultation and referral mechanism. Because the first consulting physician may come from different departments in each hospital, the judgment of the condition is especially important, and failure to identify SAP early will greatly affect the patient’s prognosis. For patients who have been judged to have SAP, it is internationally recommended that they be immediately transferred to an intensive care unit (ICU) for treatment, and for units that do not have ICU conditions, it is recommended that the transfer be completed as soon as possible, which also places higher demands on a considerable number of primary care institutions in China, and requires the establishment of an early warning mechanism and a smooth SAP patient transfer mechanism. In the choice of transportation, vehicles with monitoring equipment and respiratory support (e.g., simple ventilator) need to be selected, and the general travel time is within 3 h. Too long a time increases the risk during the transfer. MSAP is the focus of multidisciplinary interventions, and its acute treatment is based on basic treatment against inflammatory response, which requires timely multidisciplinary interventions, such as rehydration management that may require the guidance of ICU physicians, the use of Chinese medicine can effectively relieve pancreatic inflammation, and nutritional support can be completed under the guidance of nutrition specialists. In case of infection, close cooperation with pancreatic surgeons is needed to closely observe the changes of the disease and take effective intervention in time to prevent missing the best time for surgery. In fact, it is very difficult to choose the timing of surgery for pancreatic infection, and it is closely related to the appropriateness of the selection of measures for minimally invasive treatment, the rational use of antibiotics, and the surgeon’s level of handling the infection, so it needs to be judged in the context of the actual situation. However, in any case, timely surgery has positive implications for the prognosis of patients with concomitant infections. The rescue process of SAP can especially reflect the role of MDT. It is recommended to establish MDT rescue team and strive to improve the rescue success rate by organizing regular consultation and discussion among medical, surgical and ICU disciplines. Early goal-directed fluid resuscitation is one of the key measures for treatment. Fluid resuscitation is a key part of the initial treatment of SAP. Untimely rehydration will lead to prolonged circulatory failure and aggravate organ (such as liver and kidney) damage, while excessive rehydration or inappropriate ratio of crystals and limbs will easily lead to acute pulmonary edema and abdominal hypertension causing new organ failure, so the fluid resuscitation process is an important embodiment of the MDT concept. In the management of abdominal hypertension (abdominal septal compartment syndrome), the MDT consensus combines the latest advances in the field and domestic and international guidelines, especially emphasizing measures for non-surgical management, including limiting fluid input, early application of pressure-raising drugs, monitoring changes in mechanical ventilation pressure parameters, reducing the volume of cavernous organs, dilating the abdominal wall, and percutaneous laparotomy placement to drain the abdominal fluid. Only if non-operative decompression measures are ineffective, after multidisciplinary discussion can cautiously perform caesarean decompression surgery, which is very different from the previous practice of performing surgery once the diagnosis of abdominal septal compartment syndrome is made, fully reflecting the advantages of non-operative treatment. Differentiation of treatment priorities for different classifications of AP Previous guidelines related to AP were formulated in the form of diagnosis, general treatment, pharmacological treatment, and surgical treatment, while the MDT consensus divided them into common treatment measures and special treatment measures according to the treatment characteristics of different classifications of AP. For example, MAP only requires basic therapeutic measures (such as fasting, acid suppression, enzyme suppression, etc.) because of the absence of complications and the short duration of the disease, but treatment for the cause (such as cholecystitis and hyperlipidemia) is very important and has positive significance for preventing AP recurrence, which is also applicable to MSAP and SAP. In MSAP, the treatment process is relatively complex and includes maintenance of water and electrolyte balance, treatment of SIRS, nutritional support, maintenance of intestinal function, infection control, and other aspects. For SAP, maintenance of organ function and control of abdominal hypertension are the main points of its treatment that are different from MSAP. Therefore, the structure of the new MDT consensus is based on the clinical characteristics of the three major types of AP, and the main points of treatment for different APs are elaborated separately, which is more in line with clinical practice. Management of post-acute complications As the success rate of MSAP and SAP in the acute phase of salvage improves, more patients will enter the recovery phase. However, the recovery period does not mean that the disease is stable. In fact, the “second strike” due to infection is another important cause of death in patients with AP, and the management of prolonged bed rest, thrombosis due to impaired coagulation mechanisms, enlargement of pseudocysts, and pancreatic fistula are all very difficult. The MDT consensus gives detailed recommendations for the management of late complications of AP. For example, the treatment of pancreatic fistula is mainly non-surgical, including fasting, jejunal nutrition, growth inhibitor application and other measures, and most patients can heal spontaneously after 3-6 months of drainage. Stenting of the pancreatic duct via ERCP has some therapeutic effect, but pancreatic fistulas that do not close for a long time or have complications should be surgically treated. Partial pancreatectomy and fistula jejunostomy are feasible in cases of complete pancreatic duct dissection. The above description fully reflects the principles of MDT and provides clear guidance for the treatment of related complications. In conclusion, the development of MDT consensus for acute pancreatitis is the first attempt to apply the MDT concept throughout the whole life-saving process of AP, which can be used as a reference for multidisciplinary teams to carry out clinical life-saving treatment of AP. It is believed that the MDT consensus will play a greater role in guiding the treatment of AP with the continuous updating of the progress in the fields of pharmacological treatment, minimally invasive treatment, critical care medicine and surgical techniques.