TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos)

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• 作者：Seiki Kiriyama (1)
  Tadahiro Takada (2)
  Steven M. Strasberg (3)
  Joseph S. Solomkin (4)
  Toshihiko Mayumi (5)
  Henry A. Pitt (6)
  Dirk J. Gouma (7)
  O. James Garden (8)
  Markus W. Büchler (9)
  Masamichi Yokoe (10)
  Yasutoshi Kimura (11)
  Toshio Tsuyuguchi (12)
  Takao Itoi (13)
  Masahiro Yoshida (14)
  Fumihiko Miura (2)
  Yuichi Yamashita (15)
  Kohji Okamoto (16)
  Toshifumi Gabata (17)
  Jiro Hata (18)
  Ryota Higuchi (19)
  John A. Windsor (20)
  Philippus C. Bornman (21)
  Sheung-Tat Fan (22)
  Harijt Singh (23)
  Eduardo de Santibanes (24)
  Harumi Gomi (25)
  Shinya Kusachi (26)
  Atsuhiko Murata (27)
  Xiao-Ping Chen (28)
  Palepu Jagannath (29)
  SungGyu Lee (30)
  Robert Padbury (31)
  Miin-Fu Chen (32)
  Christos Dervenis (33)
  Angus C. W. Chan (34)
  Avinash N. Supe (35)
  Kui-Hin Liau (36)
  Myung-Hwan Kim (37)
  Sun-Whe Kim (38)
  
• 关键词：Acute cholangitis ; Diagnostic criteria ; Severity assessment ; Diagnostic imaging guidelines
• 刊名：Journal of Hepato-Biliary-Pancreatic Sciences
• 出版年：2013
• 出版时间：January 2013
• 年：2013
• 卷：20
• 期：1
• 页码：24-34
• 全文大小：760KB
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  8. Kiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA, et al. New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo Guidelines. J Hepatobiliary Pancreat Sci. 2012;19:548-6.
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  19. Bader TR, Braga L, Beavers KL, Semelka RC. MR imaging findings of infectious cholangitis. Magn Reson Imaging. 2001;19:781-.
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  26. Lomanto D, Pavone P, Laghi A, Panebianco V, Mazzocchi P, Fiocca F, et al. Magnetic resonance cholangiopancreatography in the diagnosis of biliopancreatic diseases. Am J Surg. 1997;174:33-.
  27. Fulcher AS, Turner MA, Capps GW, Zfass AM, Baker KM. Half-Fourier RARE MR cholangiopancreatography: experience in 300 subjects. Radiology. 1998;207:21-2.
  28. Balci NC, Semelka RC, Noone TC, Siegelman ES, de Beeck BO, Brown JJ, et al. Pyogenic hepatic abscesses: MRI findings on T1- and T2-weighted and serial gadolinium-enhanced gradient-echo images. J Magn Reson Imaging. 1999;9:285-0.
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  31. Leung JW, Chung SC, Sung JJ, Banez VP, Li AK. Urgent endoscopic drainage for acute suppurative cholangitis. Lancet. 1989;1(8650):1307-.
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• 作者单位：Seiki Kiriyama (1)
  Tadahiro Takada (2)
  Steven M. Strasberg (3)
  Joseph S. Solomkin (4)
  Toshihiko Mayumi (5)
  Henry A. Pitt (6)
  Dirk J. Gouma (7)
  O. James Garden (8)
  Markus W. Büchler (9)
  Masamichi Yokoe (10)
  Yasutoshi Kimura (11)
  Toshio Tsuyuguchi (12)
  Takao Itoi (13)
  Masahiro Yoshida (14)
  Fumihiko Miura (2)
  Yuichi Yamashita (15)
  Kohji Okamoto (16)
  Toshifumi Gabata (17)
  Jiro Hata (18)
  Ryota Higuchi (19)
  John A. Windsor (20)
  Philippus C. Bornman (21)
  Sheung-Tat Fan (22)
  Harijt Singh (23)
  Eduardo de Santibanes (24)
  Harumi Gomi (25)
  Shinya Kusachi (26)
  Atsuhiko Murata (27)
  Xiao-Ping Chen (28)
  Palepu Jagannath (29)
  SungGyu Lee (30)
  Robert Padbury (31)
  Miin-Fu Chen (32)
  Christos Dervenis (33)
  Angus C. W. Chan (34)
  Avinash N. Supe (35)
  Kui-Hin Liau (36)
  Myung-Hwan Kim (37)
  Sun-Whe Kim (38)
  
  1. Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan
  2. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
  3. Section of Hepatobiliary and Pancreatic Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
  4. Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
  5. Department of Emergency and Critical Care Medicine, Ichinomiya Municipal Hospital, Ichinomiya, Japan
  6. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
  7. Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
  8. Clinical Surgery, The University of Edinburgh, Edinburgh, UK
  9. Department of Surgery, University of Heidelberg, Heidelberg, Germany
  10. General Internal Medicine, Nagoya Daini Red Cross Hospital, Nagoya, Japan
  11. Department of Surgical Oncology and Gastroenterological Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
  12. Department of Medicine and Clinical Oncology, Graduate School of Medicine Chiba University, Chiba, Japan
  13. Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
  14. Clinical Research Center Kaken Hospital, International University of Health and Welfare, Ichikawa, Japan
  15. Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
  16. Department of Surgery, Kitakyushu Municipal Yahata Hospital, Kitakyushu, Japan
  17. Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
  18. Department of Endoscopy and Ultrasound, Kawasaki Medical School, Okayama, Japan
  19. Department of Surgery, Institute of Gastroenterology Tokyo Women’s Medical University, Tokyo, Japan
  20. Department of Surgery, The University of Auckland, Auckland, New Zealand
  21. Division of General Surgery, Health Sciences, University of Cape Town, Cape Town, South Africa
  22. Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
  23. Department of Hepato-Pancreato-Biliary Surgery, Hospital Selayang, Kuala Lampur, Malaysia
  24. Department of Surgery, Hospital Italianio, University of Buenos Aires, Buenos Aires, Argentina
  25. Center for Clinical Infectious Diseases, Jichi Medical University, Tochigi, Japan
  26. Department of Surgery, Toho University Medical Center Ohashi Hospital, Tokyo, Japan
  27. Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
  28. Hepatic Surgery Centre, Department of Surgery, Tongji Hospital, Tongi Medical College, Huazhong University of Science and Technology, Wuhan, China
  29. Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, India
  30. HepatoBiliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University, Seoul, Korea
  31. Division of Surgical and Specialty Services, Flinders Medical Centre, Adelaide, Australia
  32. Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
  33. First Department of Surgery, Agia Olga Hospital, Athens, Greece
  34. Surgery Centre, Department of Surgery, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong
  35. Department of Surgical Gastroenterology, Seth G. S. Medical College and K. E. M. Hospital, Mumbai, India
  36. Hepatobiliary and Pancreatic Surgery, Nexus Surgical Associates, Mount Elizabeth Hospital, Singapore, Singapore
  37. Department of Internal Medicine, Asan Medical Center University of Ulsan, Seoul, Korea
  38. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
  

文摘

Since the publication of the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07), diagnostic criteria and severity assessment criteria for acute cholangitis have been presented and extensively used as the primary standard all over the world. However, it has been found that there are crucial limitations in these criteria. The diagnostic criteria of TG07 do not have enough sensitivity and specificity, and its severity assessment criteria are unsuitable for clinical use. A working team for the revision of TG07 was organized in June, 2010, and these criteria have been updated through clinical implementation and its assessment by means of multi-center analysis. The diagnostic criteria of acute cholangitis have been revised as criteria to establish the diagnosis where cholestasis and inflammation demonstrated by clinical signs or blood test in addition to biliary manifestations demonstrated by imaging are present. The diagnostic criteria of the updated Tokyo Guidelines (TG13) have high sensitivity (87.6?%) and high specificity (77.7?%). TG13 has better diagnostic capacity than TG07. Severity assessment is classified as follows: Grade III: associated with organ failure; Grade II: early biliary drainage should be conducted; Grade1: others. As for the severity assessment criteria of TG07, separating Grade II and Grade I at the time of diagnosis was impossible, so they were unsuitable for clinical practice. Therefore, the severity assessment criteria of TG13 have been revised so as not to lose the timing of biliary drainage or treatment for etiology. Based on evidence, five predictive factors for poor prognosis in acute cholangitis––hyperbilirubinemia, high fever, leukocytosis, elderly patient and hypoalbuminemia––have been extracted. Grade II can be diagnosed if two of these five factors are present. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.