{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:34:14Z","timestamp":1792197254064,"version":"4.4.0"},"reference-count":40,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Acute pancreatitis (AP) is increasingly recognised as a disease with clinically significant long-term consequences. However, the extent to which aetiology influences the spectrum of long-term pancreatic sequelae remains unclear. This systematic review and meta-analysis evaluated long-term complications following a first episode of AP, with a protocol-defined focus on the impact of aetiology. Methods: This review evaluated eligible studies that included adults with a first episode of AP who were followed for chronic pancreatitis (CP), exocrine pancreatic insufficiency (EPI), or new-onset diabetes mellitus (NODM). A comprehensive search of PubMed, Scopus, Web of Science, and CENTRAL was conducted from January 2002 to June 2025. Risk of bias was assessed using the Newcastle\u2013Ottawa Scale. Random-effects meta-analyses were performed to estimate pooled incidence proportions. A prespecified network meta-analysis was not feasible because outcome-specific event counts stratified by aetiology were inconsistently reported. This study satisfied PRISMA 2020 guidelines and was registered with PROSPERO (CRD420251074032). Results: Eight studies met eligibility criteria with extractable data for quantitative synthesis. Five studies (n \u2248 10,780) reported chronic pancreatitis (CP), with a pooled incidence of approximately 7\u20138% following a first episode of acute pancreatitis (AP) and substantial heterogeneity (I2 \u2248 96%). Three studies (n = 796) reported exocrine pancreatic insufficiency (EPI), with a pooled incidence of approximately 23%, although estimates were highly heterogeneous (I2 \u2248 98%). Four studies (n = 2706; 415 events) reported new-onset diabetes mellitus (NODM), with a pooled incidence of approximately 20% (I2 \u2248 93%). Although aetiology-specific quantitative comparisons were not possible, narrative synthesis consistently demonstrated higher long-term risk following alcohol-associated AP, lower risk after biliary AP, and intermediate but variable outcomes in idiopathic AP. Conclusions: Clinically meaningful long-term pancreatic dysfunction is common after a first episode of acute pancreatitis, particularly new-onset diabetes mellitus. While aetiology-specific risks could not be quantified, consistent patterns suggest that aetiology shapes long-term outcomes. These findings support structured, aetiology-informed follow-up after acute pancreatitis and the need for standardised outcome reporting in future studies.<\/jats:p>","DOI":"10.3390\/jcm15093388","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T09:46:11Z","timestamp":1777455971000},"page":"3388","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of Acute Pancreatitis Aetiology on Long-Term Outcomes Following a First Episode of Acute Pancreatitis: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7673-6158","authenticated-orcid":false,"given":"Emmanuel Malesela","family":"Ndaba","sequence":"first","affiliation":[{"name":"Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1071-298X","authenticated-orcid":false,"given":"Jones A. O.","family":"Omoshoro-Jones","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"},{"name":"General & Hepatopancreatobiliary Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg 1864, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4026-1697","authenticated-orcid":false,"given":"Ekene Emmanuel","family":"Nweke","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3631-1893","authenticated-orcid":false,"given":"Pascaline N.","family":"Fru","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1038\/s41575-018-0087-5","article-title":"Global epidemiology and holistic prevention of pancreatitis","volume":"16","author":"Petrov","year":"2019","journal-title":"Nat. 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