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Article: New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo guidelines

TitleNew diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo guidelines
Authors
KeywordsAcute Cholangitis
Biliary Infection
Charcot's Triad
Diagnostic Criteria
Severity Assessment
Issue Date2012
PublisherSpringer Japan KK. The Journal's web site is located at http://www.springer.com/medicine/surgery/journal/534
Citation
Journal Of Hepato-Biliary-Pancreatic Sciences, 2012, v. 19 n. 5, p. 548-556 How to Cite?
AbstractBackground: 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. © 2012 The Author(s).
Persistent Identifierhttp://hdl.handle.net/10722/173036
ISSN
2015 Impact Factor: 3.146
2015 SCImago Journal Rankings: 1.446
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorKiriyama, Sen_US
dc.contributor.authorTakada, Ten_US
dc.contributor.authorStrasberg, SMen_US
dc.contributor.authorSolomkin, JSen_US
dc.contributor.authorMayumi, Ten_US
dc.contributor.authorPitt, HAen_US
dc.contributor.authorGouma, DJen_US
dc.contributor.authorGarden, OJen_US
dc.contributor.authorBüchler, MWen_US
dc.contributor.authorYokoe, Men_US
dc.contributor.authorKimura, Yen_US
dc.contributor.authorTsuyuguchi, Ten_US
dc.contributor.authorItoi, Ten_US
dc.contributor.authorYoshida, Men_US
dc.contributor.authorMiura, Fen_US
dc.contributor.authorYamashita, Yen_US
dc.contributor.authorOkamoto, Ken_US
dc.contributor.authorGabata, Ten_US
dc.contributor.authorHata, Jen_US
dc.contributor.authorHiguchi, Ren_US
dc.contributor.authorWindsor, JAen_US
dc.contributor.authorBornman, PCen_US
dc.contributor.authorFan, STen_US
dc.contributor.authorSingh, Hen_US
dc.contributor.authorDe Santibanes, Een_US
dc.contributor.authorGomi, Hen_US
dc.contributor.authorKusachi, Sen_US
dc.contributor.authorMurata, Aen_US
dc.contributor.authorChen, XPen_US
dc.contributor.authorJagannath, Pen_US
dc.contributor.authorLee, Sen_US
dc.contributor.authorPadbury, Ren_US
dc.contributor.authorChen, MFen_US
dc.date.accessioned2012-10-30T06:26:49Z-
dc.date.available2012-10-30T06:26:49Z-
dc.date.issued2012en_US
dc.identifier.citationJournal Of Hepato-Biliary-Pancreatic Sciences, 2012, v. 19 n. 5, p. 548-556en_US
dc.identifier.issn1868-6974en_US
dc.identifier.urihttp://hdl.handle.net/10722/173036-
dc.description.abstractBackground: 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. © 2012 The Author(s).en_US
dc.languageengen_US
dc.publisherSpringer Japan KK. The Journal's web site is located at http://www.springer.com/medicine/surgery/journal/534en_US
dc.relation.ispartofJournal of Hepato-Biliary-Pancreatic Sciencesen_US
dc.subjectAcute Cholangitisen_US
dc.subjectBiliary Infectionen_US
dc.subjectCharcot's Triaden_US
dc.subjectDiagnostic Criteriaen_US
dc.subjectSeverity Assessmenten_US
dc.titleNew diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo guidelinesen_US
dc.typeArticleen_US
dc.identifier.emailFan, ST: stfan@hku.hken_US
dc.identifier.authorityFan, ST=rp00355en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1007/s00534-012-0537-3en_US
dc.identifier.pmid22825491-
dc.identifier.scopuseid_2-s2.0-84867331350en_US
dc.identifier.hkuros211042-
dc.identifier.volume19-
dc.identifier.issue5-
dc.identifier.spage548en_US
dc.identifier.epage556en_US
dc.identifier.isiWOS:000312153300008-
dc.publisher.placeJapanen_US
dc.identifier.scopusauthoridKiriyama, S=26643310800en_US
dc.identifier.scopusauthoridTakada, T=7202751961en_US
dc.identifier.scopusauthoridStrasberg, SM=7101931401en_US
dc.identifier.scopusauthoridSolomkin, JS=7006149016en_US
dc.identifier.scopusauthoridMayumi, T=7102413301en_US
dc.identifier.scopusauthoridPitt, HA=7103213587en_US
dc.identifier.scopusauthoridGouma, DJ=36046572200en_US
dc.identifier.scopusauthoridGarden, OJ=7006432342en_US
dc.identifier.scopusauthoridBüchler, MW=35277875400en_US
dc.identifier.scopusauthoridYokoe, M=35204159000en_US
dc.identifier.scopusauthoridKimura, Y=7403990474en_US
dc.identifier.scopusauthoridTsuyuguchi, T=6701437594en_US
dc.identifier.scopusauthoridItoi, T=7006598184en_US
dc.identifier.scopusauthoridYoshida, M=14421962900en_US
dc.identifier.scopusauthoridMiura, F=35475649700en_US
dc.identifier.scopusauthoridYamashita, Y=7402954641en_US
dc.identifier.scopusauthoridOkamoto, K=55317449700en_US
dc.identifier.scopusauthoridGabata, T=35451751500en_US
dc.identifier.scopusauthoridHata, J=35396396800en_US
dc.identifier.scopusauthoridHiguchi, R=55317433500en_US
dc.identifier.scopusauthoridWindsor, JA=16173985400en_US
dc.identifier.scopusauthoridBornman, PC=7006718164en_US
dc.identifier.scopusauthoridFan, ST=7402678224en_US
dc.identifier.scopusauthoridSingh, H=55317409300en_US
dc.identifier.scopusauthoridde Santibanes, E=15057704700en_US
dc.identifier.scopusauthoridGomi, H=15836576100en_US
dc.identifier.scopusauthoridKusachi, S=7005805567en_US
dc.identifier.scopusauthoridMurata, A=8867169200en_US
dc.identifier.scopusauthoridChen, XP=55043884000en_US
dc.identifier.scopusauthoridJagannath, P=7003575736en_US
dc.identifier.scopusauthoridLee, S=25927169100en_US
dc.identifier.scopusauthoridPadbury, R=6603924012en_US
dc.identifier.scopusauthoridChen, MF=34874546600en_US

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