New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo guidelines View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2012-09

AUTHORS

Seiki Kiriyama, Tadahiro Takada, Steven M. Strasberg, Joseph S. Solomkin, Toshihiko Mayumi, Henry A. Pitt, Dirk J. Gouma, O. James Garden, Markus W. Büchler, Masamichi Yokoe, Yasutoshi Kimura, Toshio Tsuyuguchi, Takao Itoi, Masahiro Yoshida, Fumihiko Miura, Yuichi Yamashita, Kohji Okamoto, Toshifumi Gabata, Jiro Hata, Ryota Higuchi, John A. Windsor, Philippus C. Bornman, Sheung-Tat Fan, Harijt Singh, Eduardo de Santibanes, Harumi Gomi, Shinya Kusachi, Atsuhiko Murata, Xiao-Ping Chen, Palepu Jagannath, SungGyu Lee, Robert Padbury, Miin-Fu Chen

ABSTRACT

BACKGROUND: The Tokyo Guidelines for the management of acute cholangitis and cholecystitis were published in 2007 (TG07) and have been widely cited in the world literature. Because of new information that has been published since 2007, we organized the Tokyo Guidelines Revision Committee to conduct a multicenter analysis to develop the updated Tokyo Guidelines (TG13). METHODS/MATERIALS: We retrospectively analyzed 1,432 biliary disease cases where acute cholangitis was suspected. The cases were collected from multiple tertiary care centers in Japan. The 'gold standard' for acute cholangitis in this study was that one of the three following conditions was present: (1) purulent bile was observed; (2) clinical remission following bile duct drainage; or (3) remission was achieved by antibacterial therapy alone, in patients in whom the only site of infection was the biliary tree. Comparisons were made for the validity of each diagnostic criterion among TG13, TG07 and Charcot's triad. RESULTS: The major changes in diagnostic criteria of TG07 were re-arrangement of the diagnostic items and exclusion of abdominal pain from the diagnostic list. The sensitivity improved from 82.8 % (TG07) to 91.8 % (TG13). While the specificity was similar to TG07, the false positive rate in cases of acute cholecystitis was reduced from 15.5 to 5.9 %. The sensitivity of Charcot's triad was only 26.4 % but the specificity was 95.6 %. However, the false positive rate in cases of acute cholecystitis was 11.9 % and not negligible. As for severity grading, Grade II (moderate) acute cholangitis is defined as being associated with any two of the significant prognostic factors which were derived from evidence presented recently in the literature. The factors chosen allow severity assessment to be performed soon after diagnosis of acute cholangitis. CONCLUSION: TG13 present a new standard for the diagnosis, severity grading, and management of acute cholangitis. More... »

PAGES

548-556

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00534-012-0537-3

DOI

http://dx.doi.org/10.1007/s00534-012-0537-3

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1042684279

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/22825491


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470 schema:name Department of Surgery, University of Heidelberg, Heidelberg, Germany
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472 https://www.grid.ac/institutes/grid.7836.a schema:alternateName University of Cape Town
473 schema:name Division of General Surgery, Health Sciences, University of Cape Town, Cape Town, South Africa
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475 https://www.grid.ac/institutes/grid.9654.e schema:alternateName University of Auckland
476 schema:name Department of Surgery, The University of Auckland, Auckland, New Zealand
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478 https://www.grid.ac/institutes/grid.9707.9 schema:alternateName Kanazawa University
479 schema:name Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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