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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo guidelines
Journal of Hepato-Biliary-Pancreatic Sciences, Volume 19, No. 5, Year 2012
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Description
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. © The Author(s) 2012.
Authors & Co-Authors
Kiriyama, Seiki
Unknown Affiliation
Takada, Tadahiro
Unknown Affiliation
Strasberg, Steven M.
Unknown Affiliation
Solomkin, Joseph S.
Unknown Affiliation
Mayumi, Toshihiko
Unknown Affiliation
Pitt, Henry A.
Unknown Affiliation
Gouma, Dirk J.
Unknown Affiliation
Garden, Olivier James
Unknown Affiliation
Búchler, Markus Wolfgang
Unknown Affiliation
Yokoe, Masamichi
Unknown Affiliation
Kimura, Yasutoshi
Unknown Affiliation
Tsuyuguchi, Toshio
Unknown Affiliation
Itoi, Takao
Unknown Affiliation
Yoshida, Masahiro
Unknown Affiliation
Miura, Fumihiko
Unknown Affiliation
Yamashita, Yuichi
Unknown Affiliation
Okamoto, Kohji
Unknown Affiliation
Gabata, Toshifumi
Unknown Affiliation
Hata, Jiro
Unknown Affiliation
Higuchi, Ryota
Unknown Affiliation
Windsor, John A.
Unknown Affiliation
Bornman, Philippus C.
Unknown Affiliation
Fan, Sheung Tat
Unknown Affiliation
Singh, Harijt
Unknown Affiliation
de Santibanes, Eduardo
Unknown Affiliation
Gomi, Harumi
Unknown Affiliation
Kusachi, Shinya
Unknown Affiliation
Murata, Atsuhiko
Unknown Affiliation
Chen, Xiao Ping
Unknown Affiliation
Jagannath, Palepu
Unknown Affiliation
Lee, Sunggyu
Unknown Affiliation
Padbury, Robert T.
Unknown Affiliation
Chen, Miin Fu
Unknown Affiliation
Statistics
Citations: 130
Authors: 33
Affiliations: 33
Identifiers
Doi:
10.1007/s00534-012-0537-3
ISSN:
18686974
e-ISSN:
18686982