TG13 flowchart for the management of acute cholangitis and cholecystitis

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• 作者：Fumihiko Miura (1)
  Tadahiro Takada (1)
  Steven M. Strasberg (2)
  Joseph S. Solomkin (3)
  Henry A. Pitt (4)
  Dirk J. Gouma (5)
  O. James Garden (6)
  Markus W. Büchler (7)
  Masahiro Yoshida (8)
  Toshihiko Mayumi (9)
  Kohji Okamoto (10)
  Harumi Gomi (11)
  Shinya Kusachi (12)
  Seiki Kiriyama (13)
  Masamichi Yokoe (14)
  Yasutoshi Kimura (15)
  Ryota Higuchi (16)
  Yuichi Yamashita (17)
  John A. Windsor (18)
  Toshio Tsuyuguchi (19)
  Toshifumi Gabata (20)
  Takao Itoi (21)
  Jiro Hata (22)
  Kui-Hin Liau (23)
  
• 关键词：Acute cholangitis ; Acute cholecystitis ; Biliary drainage ; Laparoscopic cholecystectomy ; 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：47-54
• 全文大小：482KB
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  33. Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, et al. New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo guidelines. J Hepatobiliary Pancreat Sci. 2012;19:578-5. <a class="external" href="http://dx.doi.org/10.1007/s00534-012-0548-0">CrossRefa>
  34. Inui K, Nakazawa S, Naito Y, Kimoto E, Yamao K. Nonsurgical treatment of cholecystolithiasis with percutaneous transhepatic cholecystoscopy. Am J Gastroenterol. 1988;83:1124-.
  35. Boland GW, Lee MJ, Mueller PR, Dawson SL, Gaa J, Lu DS, et al. Gallstones in critically ill patients with acute calculous cholecystitis treated by percutaneous cholecystostomy: nonsurgical therapeutic options. AJR Am J Roentgenol. 1994;162:1101-.
  36. Majeed AW, Reed MW, Ross B, Peacock J, Johnson AG. Gallstone removal with a modified cholecystoscope: an alternative to cholecystectomy in the high-risk patient. J Am Coll Surg. 1997;184:273-0.
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• 作者单位：Fumihiko Miura (1)
  Tadahiro Takada (1)
  Steven M. Strasberg (2)
  Joseph S. Solomkin (3)
  Henry A. Pitt (4)
  Dirk J. Gouma (5)
  O. James Garden (6)
  Markus W. Büchler (7)
  Masahiro Yoshida (8)
  Toshihiko Mayumi (9)
  Kohji Okamoto (10)
  Harumi Gomi (11)
  Shinya Kusachi (12)
  Seiki Kiriyama (13)
  Masamichi Yokoe (14)
  Yasutoshi Kimura (15)
  Ryota Higuchi (16)
  Yuichi Yamashita (17)
  John A. Windsor (18)
  Toshio Tsuyuguchi (19)
  Toshifumi Gabata (20)
  Takao Itoi (21)
  Jiro Hata (22)
  Kui-Hin Liau (23)
  
  1. Department of Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
  2. Section of Hepatobiliary and Pancreatic Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
  3. Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
  4. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
  5. Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
  6. Clinical Surgery, The University of Edinburgh, Edinburgh, UK
  7. Department of Surgery, University of Heidelberg, Heidelberg, Germany
  8. Clinical Research Center Kaken Hospital, International University of Health and Welfare, Ichikawa, Japan
  9. Department of Emergency and Critical Care Medicine, Ichinomiya Municipal Hospital, Ichinomiya, Japan
  10. Department of Surgery, Kitakyushu Municipal Yahata Hospital, Kitakyushu, Japan
  11. Center for Clinical Infectious Diseases, Jichi Medical University, Shimotsuke, Tochigi, Japan
  12. Department of Surgery, Toho University Medical Center Ohashi Hospital, Tokyo, Japan
  13. Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
  14. General Internal Medicine, Nagoya Daini Red Cross Hospital, Nagoya, Japan
  15. Department of Surgical Oncology and Gastroenterological Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
  16. Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
  17. Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
  18. Department of Surgery, The University of Auckland, Auckland, New Zealand
  19. Department of Medicine and Clinical Oncology, Graduate School of Medicine Chiba University, Chiba, Japan
  20. Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
  21. Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
  22. Department of Endoscopy and Ultrasound, Kawasaki Medical School, Okayama, Japan
  23. Hepatobiliary and Pancreatic Surgery, Nexus Surgical Associates, Mount Elizabeth Hospital, Singapore, Singapore
  

文摘

We propose a management strategy for acute cholangitis and cholecystitis according to the severity assessment. For Grade I (mild) acute cholangitis, initial medical treatment including the use of antimicrobial agents may be sufficient for most cases. For non-responders to initial medical treatment, biliary drainage should be considered. For Grade II (moderate) acute cholangitis, early biliary drainage should be performed along with the administration of antibiotics. For Grade III (severe) acute cholangitis, appropriate organ support is required. After hemodynamic stabilization has been achieved, urgent endoscopic or percutaneous transhepatic biliary drainage should be performed. In patients with Grade II (moderate) and Grade III (severe) acute cholangitis, treatment for the underlying etiology including endoscopic, percutaneous, or surgical treatment should be performed after the patient’s general condition has been improved. In patients with Grade I (mild) acute cholangitis, treatment for etiology such as endoscopic sphincterotomy for choledocholithiasis might be performed simultaneously, if possible, with biliary drainage. Early laparoscopic cholecystectomy is the first-line treatment in patients with Grade I (mild) acute cholecystitis while in patients with Grade II (moderate) acute cholecystitis, delayed/elective laparoscopic cholecystectomy after initial medical treatment with antimicrobial agent is the first-line treatment. In non-responders to initial medical treatment, gallbladder drainage should be considered. In patients with Grade III (severe) acute cholecystitis, appropriate organ support in addition to initial medical treatment is necessary. Urgent or early gallbladder drainage is recommended. Elective cholecystectomy can be performed after the improvement of the acute inflammatory process. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.