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

Seiki Kiriyama, Tadahiro Takada, Steven M. Strasberg, Joseph S. Solomkin, Toshihiko Mayumi, Henry A. Pitt, Dirk J. Gouma, O. James Garden, Markus W. Büchler, Masamichi Yokoe, Yasutoshi Kimura, Toshio Tsuyuguchi, Takao Itoi, Masahiro Yoshida, Fumihiko Miura, Yuichi Yamashita, Kohji Okamoto, Toshifumi Gabata, Jiro Hata, Ryota Higuchi & 13 others John A. Windsor, Philippus C. Bornman, Sheung Tat Fan, Harijt Singh, Eduardo De Santibanes, Harumi Gomi, Shinya Kusachi, Atsuhiko Murata, Xiao Ping Chen, Palepu Jagannath, Sunggyu Lee, Robert Padbury, Miin Fu Chen

Research output: Contribution to journalArticle

Abstract

Background: 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.

Original languageEnglish (US)
Pages (from-to)548-556
Number of pages9
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Volume19
Issue number5
DOIs
StatePublished - Sep 2012
Externally publishedYes

Fingerprint

Cholangitis
Tokyo
Guidelines
Acute Cholecystitis
Biliary Tract
Acute Disease
Bile Ducts
Tertiary Care Centers
Bile
Abdominal Pain
Drainage
Japan
Infection

Keywords

  • Acute cholangitis
  • Biliary infection
  • Charcot's triad
  • Diagnostic criteria
  • Severity assessment

ASJC Scopus subject areas

  • Hepatology
  • Surgery

Cite this

Kiriyama, S., Takada, T., Strasberg, S. M., Solomkin, J. S., Mayumi, T., Pitt, H. A., ... Chen, M. F. (2012). New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo guidelines. Journal of Hepato-Biliary-Pancreatic Sciences, 19(5), 548-556. https://doi.org/10.1007/s00534-012-0537-3

New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo guidelines. / Kiriyama, Seiki; Takada, Tadahiro; Strasberg, Steven M.; Solomkin, Joseph S.; Mayumi, Toshihiko; Pitt, Henry A.; Gouma, Dirk J.; Garden, O. James; Büchler, Markus W.; Yokoe, Masamichi; Kimura, Yasutoshi; Tsuyuguchi, Toshio; Itoi, Takao; Yoshida, Masahiro; Miura, Fumihiko; Yamashita, Yuichi; Okamoto, Kohji; Gabata, Toshifumi; Hata, Jiro; Higuchi, Ryota; Windsor, John A.; Bornman, Philippus C.; Fan, Sheung Tat; Singh, Harijt; De Santibanes, Eduardo; Gomi, Harumi; Kusachi, Shinya; Murata, Atsuhiko; Chen, Xiao Ping; Jagannath, Palepu; Lee, Sunggyu; Padbury, Robert; Chen, Miin Fu.

In: Journal of Hepato-Biliary-Pancreatic Sciences, Vol. 19, No. 5, 09.2012, p. 548-556.

Research output: Contribution to journalArticle

Kiriyama, S, Takada, T, Strasberg, SM, Solomkin, JS, Mayumi, T, Pitt, HA, Gouma, DJ, Garden, OJ, Büchler, MW, Yokoe, M, Kimura, Y, Tsuyuguchi, T, Itoi, T, Yoshida, M, Miura, F, Yamashita, Y, Okamoto, K, Gabata, T, Hata, J, Higuchi, R, Windsor, JA, Bornman, PC, Fan, ST, Singh, H, De Santibanes, E, Gomi, H, Kusachi, S, Murata, A, Chen, XP, Jagannath, P, Lee, S, Padbury, R & Chen, MF 2012, 'New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo guidelines', Journal of Hepato-Biliary-Pancreatic Sciences, vol. 19, no. 5, pp. 548-556. https://doi.org/10.1007/s00534-012-0537-3
Kiriyama, Seiki ; Takada, Tadahiro ; Strasberg, Steven M. ; Solomkin, Joseph S. ; Mayumi, Toshihiko ; Pitt, Henry A. ; Gouma, Dirk J. ; Garden, O. James ; Büchler, Markus W. ; Yokoe, Masamichi ; Kimura, Yasutoshi ; Tsuyuguchi, Toshio ; Itoi, Takao ; Yoshida, Masahiro ; Miura, Fumihiko ; Yamashita, Yuichi ; Okamoto, Kohji ; Gabata, Toshifumi ; Hata, Jiro ; Higuchi, Ryota ; Windsor, John A. ; Bornman, Philippus C. ; Fan, Sheung Tat ; Singh, Harijt ; De Santibanes, Eduardo ; Gomi, Harumi ; Kusachi, Shinya ; Murata, Atsuhiko ; Chen, Xiao Ping ; Jagannath, Palepu ; Lee, Sunggyu ; Padbury, Robert ; Chen, Miin Fu. / New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo guidelines. In: Journal of Hepato-Biliary-Pancreatic Sciences. 2012 ; Vol. 19, No. 5. pp. 548-556.
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abstract = "Background: 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.",
keywords = "Acute cholangitis, Biliary infection, Charcot's triad, Diagnostic criteria, Severity assessment",
author = "Seiki Kiriyama and Tadahiro Takada and Strasberg, {Steven M.} and Solomkin, {Joseph S.} and Toshihiko Mayumi and Pitt, {Henry A.} and Gouma, {Dirk J.} and Garden, {O. James} and B{\"u}chler, {Markus W.} and Masamichi Yokoe and Yasutoshi Kimura and Toshio Tsuyuguchi and Takao Itoi and Masahiro Yoshida and Fumihiko Miura and Yuichi Yamashita and Kohji Okamoto and Toshifumi Gabata and Jiro Hata and Ryota Higuchi and Windsor, {John A.} and Bornman, {Philippus C.} and Fan, {Sheung Tat} and Harijt Singh and {De Santibanes}, Eduardo and Harumi Gomi and Shinya Kusachi and Atsuhiko Murata and Chen, {Xiao Ping} and Palepu Jagannath and Sunggyu Lee and Robert Padbury and Chen, {Miin Fu}",
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T1 - New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo guidelines

AU - Kiriyama, Seiki

AU - Takada, Tadahiro

AU - Strasberg, Steven M.

AU - Solomkin, Joseph S.

AU - Mayumi, Toshihiko

AU - Pitt, Henry A.

AU - Gouma, Dirk J.

AU - Garden, O. James

AU - Büchler, Markus W.

AU - Yokoe, Masamichi

AU - Kimura, Yasutoshi

AU - Tsuyuguchi, Toshio

AU - Itoi, Takao

AU - Yoshida, Masahiro

AU - Miura, Fumihiko

AU - Yamashita, Yuichi

AU - Okamoto, Kohji

AU - Gabata, Toshifumi

AU - Hata, Jiro

AU - Higuchi, Ryota

AU - Windsor, John A.

AU - Bornman, Philippus C.

AU - Fan, Sheung Tat

AU - Singh, Harijt

AU - De Santibanes, Eduardo

AU - Gomi, Harumi

AU - Kusachi, Shinya

AU - Murata, Atsuhiko

AU - Chen, Xiao Ping

AU - Jagannath, Palepu

AU - Lee, Sunggyu

AU - Padbury, Robert

AU - Chen, Miin Fu

PY - 2012/9

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N2 - Background: 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.

AB - Background: 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.

KW - Acute cholangitis

KW - Biliary infection

KW - Charcot's triad

KW - Diagnostic criteria

KW - Severity assessment

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