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

Research output: Contribution to journalArticle

72 Citations (Scopus)

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 languageEnglish
Pages (from-to)17-30
Number of pages14
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Volume25
Issue number1
DOIs
Publication statusPublished - 01-2018

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Fingerprint Dive into the research topics of 'Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)'. Together they form a unique fingerprint.

  • Cite this

    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