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

Journal of Hepato-Biliary-Pancreatic Sciences - 2012
Masamichi Yokoe1, Tadahiro Takada2, Steven M. Strasberg3, Joseph S. Solomkin4, Toshihiko Mayumi5, Harumi Gomi6, Henry A. Pitt7, Dirk J. Gouma8, O. James Garden9, Markus W. Büchler10, Seiki Kiriyama11, Yasutoshi Kimura12, Toshio Tsuyuguchi13, Takao Itoi14, Masahiro Yoshida15, Fumihiko Miura2, Yuichi Yamashita16, Kohji Okamoto17, Toshifumi Gabata18, Jiro Hata19, Ryota Higuchi20, John A. Windsor21, Philippus C. Bornman22, Sheung–Tat Fan23, Harijt Singh24, Eduardo de Santibañés25, Shozo Kusachi26, Atsuhiko Murata27, Xiaoping Chen28, P. Jagannath29, Sung Gyu Lee30, Robert Padbury31, Miin‐Fu Chen32
1General Internal Medicine, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 466-8650 Japan
2Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
3Section of Hepatobiliary and Pancreatic Surgery Washington University in Saint Louis School of Medicine Saint Louis MO USA
4Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
5Department of Emergency and Critical Care Medicine, Ichinomiya Municipal Hospital, Ichinomiya, Japan
6Center for Clinical Infectious Diseases; Jichi Medical University; Tochigi Japan
7Department of Surgery, Indiana University School of Medicine, Indianapolis IN USA
8Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
9Clinical Surgery, The University of Edinburgh, Edinburgh, UK
10Department of Surgery, University of Heidelberg, Heidelberg, Germany
11Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
12Department of Surgical Oncology and Gastroenterological Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
13Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba , Japan
14Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
15Clinical Research Center Kaken Hospital, International University of Health and Welfare, Ichikawa, Japan
16Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
17Department of Surgery Kitakyushu Municipal Yahata Hospital Kitakyushu Japan
18Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
19Department of Endoscopy and Ultrasound, Kawasaki Medical School, Okayama, Japan
20Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
21Department of Surgery, The University of Auckland, Auckland, New Zealand
22Division of General Surgery, Health Sciences, University of Cape Town, Cape Town, South Africa
23Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
24Department of Hepato-Pancreato-Biliary Surgery, Hospital Selayang, Kuala Lampur, Malaysia
25Department of Surgery, Hospital Italianio, University of Buenos Aires, Buenos Aires, Argentina
26Department of Surgery, Toho University Medical Center Ohashi Hospital, Tokyo, Japan
27Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
28Hepatic Surgery Centre, Department of Surgery Tongji Hospital, Tongi Medical College, Huazhong University of Science and Technology Wuhan China
29Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, India
30HepatoBiliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University, Ulsan, Korea
31Division of Surgical and Specialty Services, Flinders Medical Centre, Adelaide, Australia
32Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan

Tóm tắt

AbstractBackgroundThe Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) were published in 2007 as the world's first guidelines for acute cholangitis and cholecystitis. The diagnostic criteria and severity assessment of acute cholecystitis have since been widely used all over the world. A validation study of TG07 has shown that the diagnostic criteria for acute cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. In addition, considerable new evidence referring to acute cholecystitis as well as evaluations of TG07 have been published. Consequently, we organized the Tokyo Guidelines Revision Committee to evaluate TG07, recognize new evidence, and conduct a multi‐center analysis to revise the guidelines (TG13).Methods and materialsWe retrospectively analyzed 451 patients with acute cholecystitis from multiple tertiary care centers in Japan. All 451 patients were first evaluated using the criteria in TG07. The “gold standard” for acute cholecystitis in this study was a diagnosis by pathology. The validity of TG07 diagnostic criteria was investigated by comparing clinical with pathological diagnosis.ResultsOf 451 patients evaluated, a total of 227 patients were given a diagnosis of acute cholecystitis by pathological examination (prevalence 50.3 %). TG07 criteria provided a definite diagnosis of acute cholecystitis in 224 patients. The sensitivity of TG07 diagnostic criteria for acute cholecystitis was 92.1 %, and the specificity was 93.3 %. Based on the preliminary results, new diagnostic criteria for acute cholecystitis were proposed. Using the new criteria, the sensitivity of definite diagnosis was 91.2 %, and the specificity was 96.9 %. The accuracy rate was improved from 92.7 to 94.0 %. In regard to severity grading among 227 patients, 111 patients were classified as Mild (Grade I), 104 as Moderate (Grade II), and 12 as Severe (Grade III).ConclusionThe proposed new diagnostic criteria achieved better performance than the diagnostic criteria in TG07. Therefore, the proposed criteria have been adopted as new diagnostic criteria for acute cholecystitis and are referred to as the 2013 Tokyo Guidelines (TG13). Regarding severity assessment, no new evidence was found to suggest that the criteria in TG07 needed major adjustment. As a result, TG07 severity assessment criteria have been adopted in TG13 with minor changes.

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