Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)

Seiki Kiriyama; Kazuto Kozaka; Tadahiro Takada; Steven M. Strasberg; Henry A. Pitt; Toshifumi Gabata; Jiro Hata; Kui Hin Liau; Fumihiko Miura; Akihiko Horiguchi; Keng Hao Liu; Cheng Hsi Su; Keita Wada; Palepu Jagannath; Takao Itoi; Dirk J. Gouma; Yasuhisa Mori; Shuntaro Mukai; Mariano Eduardo Giménez; Wayne Shih Wei Huang; Myung Hwan Kim; Kohji Okamoto; Giulio Belli; Christos Dervenis; Angus C.W. Chan; Wan Yee Lau; Itaru Endo; Harumi Gomi; Masahiro Yoshida; Toshihiko Mayumi; Todd H. Baron; Eduardo de Santibañes; Anthony Yuen Bun Teoh; Tsann Long Hwang; Chen Guo Ker; Miin Fu Chen; Ho Seong Han; Yoo Seok Yoon; In Seok Choi; Dong Sup Yoon; Ryota Higuchi; Seigo Kitano; Masafumi Inomata; Daniel J. Deziel; Eduard Jonas; Koichi Hirata; Yoshinobu Sumiyama; Kazuo Inui; Masakazu Yamamoto

doi:10.1002/jhbp.512

Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)

Seiki Kiriyama, Kazuto Kozaka, Tadahiro Takada, Steven M. Strasberg, Henry A. Pitt, Toshifumi Gabata, Jiro Hata, Kui Hin Liau, Fumihiko Miura, Akihiko Horiguchi, Keng Hao Liu, Cheng Hsi Su, Keita Wada, Palepu Jagannath, Takao Itoi, Dirk J. Gouma, Yasuhisa Mori, Shuntaro Mukai, Mariano Eduardo Giménez, Wayne Shih Wei HuangMyung Hwan Kim, Kohji Okamoto, Giulio Belli, Christos Dervenis, Angus C.W. Chan, Wan Yee Lau, Itaru Endo, Harumi Gomi, Masahiro Yoshida, Toshihiko Mayumi, Todd H. Baron, Eduardo de Santibañes, Anthony Yuen Bun Teoh, Tsann Long Hwang, Chen Guo Ker, Miin Fu Chen, Ho Seong Han, Yoo Seok Yoon, In Seok Choi, Dong Sup Yoon, Ryota Higuchi, Seigo Kitano, Masafumi Inomata, Daniel J. Deziel, Eduard Jonas, Koichi Hirata, Yoshinobu Sumiyama, Kazuo Inui, Masakazu Yamamoto

Department of Surgery

Research output: Contribution to journal › Article › peer-review

411 Scopus citations

Abstract

Although the diagnostic and severity grading criteria on the 2013 Tokyo Guidelines (TG13) are used worldwide as the primary standard for management of acute cholangitis (AC), they need to be validated through implementation and assessment in actual clinical practice. Here, we conduct a systematic review of the literature to validate the TG13 diagnostic and severity grading criteria for AC and propose TG18 criteria. While there is little evidence evaluating the TG13 criteria, they were validated through a large-scale case series study in Japan and Taiwan. Analyzing big data from this study confirmed that the diagnostic rate of AC based on the TG13 diagnostic criteria was higher than that based on the TG07 criteria, and that 30-day mortality in patients with a higher severity based on the TG13 severity grading criteria was significantly higher. Furthermore, a comparison of patients treated with early or urgent biliary drainage versus patients not treated this way showed no difference in 30-day mortality among patients with Grade I or Grade III AC, but significantly lower 30-day mortality in patients with Grade II AC who were treated with early or urgent biliary drainage. This suggests that the TG13 severity grading criteria can be used to identify Grade II patients whose prognoses may be improved through biliary drainage. The TG13 severity grading criteria may therefore be useful as an indicator for biliary drainage as well as a predictive factor when assessing the patient's prognosis. The TG13 diagnostic and severity grading criteria for AC can provide results quickly, are minimally invasive for the patients, and are inexpensive. We recommend that the TG13 criteria be adopted in the TG18 guidelines and used as standard practice in the clinical setting. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

Original language	English
Pages (from-to)	17-30
Number of pages	14
Journal	Journal of Hepato-Biliary-Pancreatic Sciences
Volume	25
Issue number	1
DOIs	https://doi.org/10.1002/jhbp.512
State	Published - Jan 2018

Keywords

Acute cholangitis
Diagnostic criteria
Diagnostic imaging
Guidelines
Severity grading

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Kiriyama, S., Kozaka, K., Takada, T., Strasberg, S. M., Pitt, H. A., Gabata, T., Hata, J., Liau, K. H., Miura, F., Horiguchi, A., Liu, K. H., Su, C. H., Wada, K., Jagannath, P., Itoi, T., Gouma, D. J., Mori, Y., Mukai, S., Giménez, M. E., ... Yamamoto, M. (2018). Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). Journal of Hepato-Biliary-Pancreatic Sciences, 25(1), 17-30. https://doi.org/10.1002/jhbp.512

@article{f1c2732f307c4490ab4ce2e3c30a896a,

title = "Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)",

abstract = "Although the diagnostic and severity grading criteria on the 2013 Tokyo Guidelines (TG13) are used worldwide as the primary standard for management of acute cholangitis (AC), they need to be validated through implementation and assessment in actual clinical practice. Here, we conduct a systematic review of the literature to validate the TG13 diagnostic and severity grading criteria for AC and propose TG18 criteria. While there is little evidence evaluating the TG13 criteria, they were validated through a large-scale case series study in Japan and Taiwan. Analyzing big data from this study confirmed that the diagnostic rate of AC based on the TG13 diagnostic criteria was higher than that based on the TG07 criteria, and that 30-day mortality in patients with a higher severity based on the TG13 severity grading criteria was significantly higher. Furthermore, a comparison of patients treated with early or urgent biliary drainage versus patients not treated this way showed no difference in 30-day mortality among patients with Grade I or Grade III AC, but significantly lower 30-day mortality in patients with Grade II AC who were treated with early or urgent biliary drainage. This suggests that the TG13 severity grading criteria can be used to identify Grade II patients whose prognoses may be improved through biliary drainage. The TG13 severity grading criteria may therefore be useful as an indicator for biliary drainage as well as a predictive factor when assessing the patient's prognosis. The TG13 diagnostic and severity grading criteria for AC can provide results quickly, are minimally invasive for the patients, and are inexpensive. We recommend that the TG13 criteria be adopted in the TG18 guidelines and used as standard practice in the clinical setting. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.",

keywords = "Acute cholangitis, Diagnostic criteria, Diagnostic imaging, Guidelines, Severity grading",

author = "Seiki Kiriyama and Kazuto Kozaka and Tadahiro Takada and Strasberg, {Steven M.} and Pitt, {Henry A.} and Toshifumi Gabata and Jiro Hata and Liau, {Kui Hin} and Fumihiko Miura and Akihiko Horiguchi and Liu, {Keng Hao} and Su, {Cheng Hsi} and Keita Wada and Palepu Jagannath and Takao Itoi and Gouma, {Dirk J.} and Yasuhisa Mori and Shuntaro Mukai and Gim{\'e}nez, {Mariano Eduardo} and Huang, {Wayne Shih Wei} and Kim, {Myung Hwan} and Kohji Okamoto and Giulio Belli and Christos Dervenis and Chan, {Angus C.W.} and Lau, {Wan Yee} and Itaru Endo and Harumi Gomi and Masahiro Yoshida and Toshihiko Mayumi and Baron, {Todd H.} and {de Santiba{\~n}es}, Eduardo and Teoh, {Anthony Yuen Bun} and Hwang, {Tsann Long} and Ker, {Chen Guo} and Chen, {Miin Fu} and Han, {Ho Seong} and Yoon, {Yoo Seok} and Choi, {In Seok} and Yoon, {Dong Sup} and Ryota Higuchi and Seigo Kitano and Masafumi Inomata and Deziel, {Daniel J.} and Eduard Jonas and Koichi Hirata and Yoshinobu Sumiyama and Kazuo Inui and Masakazu Yamamoto",

note = "Publisher Copyright: {\textcopyright} 2018 Japanese Society of Hepato-Biliary-Pancreatic Surgery",

year = "2018",

month = jan,

doi = "10.1002/jhbp.512",

language = "English",

volume = "25",

pages = "17--30",

journal = "Journal of Hepato-Biliary-Pancreatic Sciences",

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Kiriyama, S, Kozaka, K, Takada, T, Strasberg, SM, Pitt, HA, Gabata, T, Hata, J, Liau, KH, Miura, F, Horiguchi, A, Liu, KH, Su, CH, Wada, K, Jagannath, P, Itoi, T, Gouma, DJ, Mori, Y, Mukai, S, Giménez, ME, Huang, WSW, Kim, MH, Okamoto, K, Belli, G, Dervenis, C, Chan, ACW, Lau, WY, Endo, I, Gomi, H, Yoshida, M, Mayumi, T, Baron, TH, de Santibañes, E, Teoh, AYB, Hwang, TL, Ker, CG, Chen, MF, Han, HS, Yoon, YS, Choi, IS, Yoon, DS, Higuchi, R, Kitano, S, Inomata, M, Deziel, DJ, Jonas, E, Hirata, K, Sumiyama, Y, Inui, K & Yamamoto, M 2018, 'Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)', Journal of Hepato-Biliary-Pancreatic Sciences, vol. 25, no. 1, pp. 17-30. https://doi.org/10.1002/jhbp.512

TY - JOUR

T1 - Tokyo Guidelines 2018

T2 - diagnostic criteria and severity grading of acute cholangitis (with videos)

AU - Kiriyama, Seiki

AU - Kozaka, Kazuto

AU - Takada, Tadahiro

AU - Strasberg, Steven M.

AU - Pitt, Henry A.

AU - Gabata, Toshifumi

AU - Hata, Jiro

AU - Liau, Kui Hin

AU - Miura, Fumihiko

AU - Horiguchi, Akihiko

AU - Liu, Keng Hao

AU - Su, Cheng Hsi

AU - Wada, Keita

AU - Jagannath, Palepu

AU - Itoi, Takao

AU - Gouma, Dirk J.

AU - Mori, Yasuhisa

AU - Mukai, Shuntaro

AU - Giménez, Mariano Eduardo

AU - Huang, Wayne Shih Wei

AU - Kim, Myung Hwan

AU - Okamoto, Kohji

AU - Belli, Giulio

AU - Dervenis, Christos

AU - Chan, Angus C.W.

AU - Lau, Wan Yee

AU - Endo, Itaru

AU - Gomi, Harumi

AU - Yoshida, Masahiro

AU - Mayumi, Toshihiko

AU - Baron, Todd H.

AU - de Santibañes, Eduardo

AU - Teoh, Anthony Yuen Bun

AU - Hwang, Tsann Long

AU - Ker, Chen Guo

AU - Chen, Miin Fu

AU - Han, Ho Seong

AU - Yoon, Yoo Seok

AU - Choi, In Seok

AU - Yoon, Dong Sup

AU - Higuchi, Ryota

AU - Kitano, Seigo

AU - Inomata, Masafumi

AU - Deziel, Daniel J.

AU - Jonas, Eduard

AU - Hirata, Koichi

AU - Sumiyama, Yoshinobu

AU - Inui, Kazuo

AU - Yamamoto, Masakazu

PY - 2018/1

Y1 - 2018/1

N2 - Although the diagnostic and severity grading criteria on the 2013 Tokyo Guidelines (TG13) are used worldwide as the primary standard for management of acute cholangitis (AC), they need to be validated through implementation and assessment in actual clinical practice. Here, we conduct a systematic review of the literature to validate the TG13 diagnostic and severity grading criteria for AC and propose TG18 criteria. While there is little evidence evaluating the TG13 criteria, they were validated through a large-scale case series study in Japan and Taiwan. Analyzing big data from this study confirmed that the diagnostic rate of AC based on the TG13 diagnostic criteria was higher than that based on the TG07 criteria, and that 30-day mortality in patients with a higher severity based on the TG13 severity grading criteria was significantly higher. Furthermore, a comparison of patients treated with early or urgent biliary drainage versus patients not treated this way showed no difference in 30-day mortality among patients with Grade I or Grade III AC, but significantly lower 30-day mortality in patients with Grade II AC who were treated with early or urgent biliary drainage. This suggests that the TG13 severity grading criteria can be used to identify Grade II patients whose prognoses may be improved through biliary drainage. The TG13 severity grading criteria may therefore be useful as an indicator for biliary drainage as well as a predictive factor when assessing the patient's prognosis. The TG13 diagnostic and severity grading criteria for AC can provide results quickly, are minimally invasive for the patients, and are inexpensive. We recommend that the TG13 criteria be adopted in the TG18 guidelines and used as standard practice in the clinical setting. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

AB - Although the diagnostic and severity grading criteria on the 2013 Tokyo Guidelines (TG13) are used worldwide as the primary standard for management of acute cholangitis (AC), they need to be validated through implementation and assessment in actual clinical practice. Here, we conduct a systematic review of the literature to validate the TG13 diagnostic and severity grading criteria for AC and propose TG18 criteria. While there is little evidence evaluating the TG13 criteria, they were validated through a large-scale case series study in Japan and Taiwan. Analyzing big data from this study confirmed that the diagnostic rate of AC based on the TG13 diagnostic criteria was higher than that based on the TG07 criteria, and that 30-day mortality in patients with a higher severity based on the TG13 severity grading criteria was significantly higher. Furthermore, a comparison of patients treated with early or urgent biliary drainage versus patients not treated this way showed no difference in 30-day mortality among patients with Grade I or Grade III AC, but significantly lower 30-day mortality in patients with Grade II AC who were treated with early or urgent biliary drainage. This suggests that the TG13 severity grading criteria can be used to identify Grade II patients whose prognoses may be improved through biliary drainage. The TG13 severity grading criteria may therefore be useful as an indicator for biliary drainage as well as a predictive factor when assessing the patient's prognosis. The TG13 diagnostic and severity grading criteria for AC can provide results quickly, are minimally invasive for the patients, and are inexpensive. We recommend that the TG13 criteria be adopted in the TG18 guidelines and used as standard practice in the clinical setting. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

KW - Acute cholangitis

KW - Diagnostic criteria

KW - Diagnostic imaging

KW - Guidelines

KW - Severity grading

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DO - 10.1002/jhbp.512

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C2 - 29032610

AN - SCOPUS:85040710373

SN - 1868-6974

VL - 25

SP - 17

EP - 30

JO - Journal of Hepato-Biliary-Pancreatic Sciences

JF - Journal of Hepato-Biliary-Pancreatic Sciences

IS - 1

ER -

Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)

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Keywords

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