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Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)
Open accessAbstract
Although the diagnostic and severity grading criteria on the 2013 Tokyo Guidelines ( TG 13) 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 TG 13 diagnostic and severity grading criteria for AC and propose TG 18 criteria. While there is little evidence evaluating the TG 13 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 TG 13 diagnostic criteria was higher than that based on the TG 07 criteria, and that 30‐day mortality in patients with a higher severity based on the TG 13 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 TG 13 severity grading criteria can be used to identify Grade II patients whose prognoses may be improved through biliary drainage. The TG 13 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 TG 13 diagnostic and severity grading criteria for AC can provide results quickly, are minimally invasive for the patients, and are inexpensive. We recommend that the TG 13 criteria be adopted in the TG 18 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.
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“Standard definitions for acute cholangitis (Tokyo guidelines) 222 may not be universally applicable. 1”
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Metadata
- Authors
- Kiriyama, S., Kozaka, K., Takada, T., Strasberg, S. M., Pitt, H. A., Gabata, T., Hata, J., Liau, K., Miura, F., Horiguchi, A., Liu, K., Su, C., Wada, K., Jagannath, P., Itoi, T., Gouma, D. J., Mori, Y., Mukai, S., Giménez, M. E., Huang, W. S., Kim, M., Okamoto, K., Belli, G., Dervenis, C., Chan, A. C. W., Lau, W. Y., Endo, I., Gomi, H., Yoshida, M., Mayumi, T., Baron, T. H., de Santibañes, E., Teoh, A. Y. B., Hwang, T., Ker, C., Chen, M., Han, H., Yoon, Y., Choi, I., Yoon, D., Higuchi, R., Kitano, S., Inomata, M., Deziel, D. J., Jonas, E., Hirata, K., Sumiyama, Y., Inui, K., & Yamamoto, M.
- Affiliations
- Ogaki Municipal Hospital (JP)
- Kanazawa University (JP)
- Teikyo University (JP)
- Washington University in St. Louis (US)
- Temple University (US)
- Kanazawa University Hospital (JP)
- Kawasaki Medical School (JP)
- National University of Singapore (SG)
- Fujita Health University (JP)
- Taoyuan Chang Gung Memorial Hospital (TW)
- Cheng Hsin General Hospital (TW)
- Lilavati Hospital & Research Centre (IN)
- Tokyo Medical University Hospital (JP)
- Amsterdam UMC Location University of Amsterdam (NL)
- Kyushu University (JP)
- Universidad de Buenos Aires (AR)
- Chang Bing Show Chwan Memorial Hospital (TW)
- University of Ulsan (KR)
- Kitakyushu City Hospital Organization (JP)
- Ospedale Santa Maria di Loreto Nuovo (IT)
- Agia Olga Hospital (GR)
- Hong Kong Sanatorium and Hospital (HK)
- Chinese University of Hong Kong (HK)
- Yokohama City University (JP)
- University of Tsukuba (JP)
- Japan Council for Quality Health Care (JP)
- University of Occupational and Environmental Health Japan (JP)
- University of North Carolina at Chapel Hill (US)
- Department of Surgery, Hospital Italiano University of Buenos Aires Buenos Aires Argentina
- Yuan's General Hospital (TW)
- Seoul National University (KR)
- Konyang University Hospital (KR)
- Yonsei University (KR)
- Tokyo Women's Medical University (JP)
- Oita University (JP)
- Rush University Medical Center (US)
- University of Cape Town (ZA)
- JR Sapporo Hospital (JP)
- Toho University (JP)
- Corresponding author
- Takada, Tadahiro
- ORCID
- Kiriyama, Seiki
- Kozaka, Kazuto
- Takada, Tadahiro
- Strasberg, Steven M.
- Pitt, Henry A.
- Gabata, Toshifumi
- Hata, Jiro
- Horiguchi, Akihiko
- Jagannath, Palepu
- Itoi, Takao
- Mori, Yasuhisa
- Mukai, Shuntaro
- Giménez, Mariano Eduardo
- Kim, Myung‐Hwan
- Okamoto, Kohji
- Lau, Wan Yee
- Endo, Itaru
- Gomi, Harumi
- Yoshida, Masahiro
- Mayumi, Toshihiko
- Baron, Todd H.
- Teoh, Anthony Yuen Bun
- Hwang, Tsann‐Long
- Ker, Chen‐Guo
- Chen, Miin‐Fu
- Han, Ho‐Seong
- Yoon, Yoo‐Seok
- Choi, In‐Seok
- Yoon, Dong‐Sup
- Higuchi, Ryota
- Inomata, Masafumi
- Jonas, Eduard
- Hirata, Koichi
- Yamamoto, Masakazu
- Venue
- Journal of Hepato-Biliary-Pancreatic Sciences
- Publisher
- Wiley
- Published
- 2018-01
- Volume
- 25
- Issue
- 1
- Pages
- 17-30
- ISSN
- 1868-6974 (ISSN-L)
- 1868-6982
- OpenAlex
- W4240528708
- Cited by
- 761
- References
- 44
- Citations by year
- 2026: 118 · 2025: 106 · 2024: 116 · 2023: 113 · 2022: 104 · 2021: 99 · 2020: 54 · 2019: 36 · 2018: 8
- FWCI
- 5.04
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amsterdamumc.nl
- Licence
- Locations
- Journal of Hepato-Biliary-Pancreatic Sciences (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Institutional Repositories DataBase (IRDB) (submittedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gallbladder and Bile Duct Disorders
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Keywords
- acute cholangitis, Tokyo Guidelines 2018, diagnostic criteria, severity classification, biliary drainage, 30-day mortality, prognostic factors
- MeSH terms
- Acute Disease, Biopsy, Needle, Cholangitis, Female, Humans, Immunohistochemistry, Magnetic Resonance Imaging, Male, Severity of Illness Index, Tokyo, Tomography, X-Ray Computed, Survival Rate, Practice Guidelines as Topic, Risk Assessment, Ultrasonography, Doppler, Early Diagnosis, Multimodal Imaging
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