TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis

Journal of Hepato-Biliary-Pancreatic Sciences - Tập 20 - Trang 1-7 - 2013
Tadahiro Takada1, Steven M. Strasberg2, Joseph S. Solomkin3, Henry A. Pitt4, Harumi Gomi5, Masahiro Yoshida6, Toshihiko Mayumi7, Fumihiko Miura1, Dirk J. Gouma8, O. James Garden9, Markus W. Büchler10, Seiki Kiriyama11, Masamichi Yokoe12, Yasutoshi Kimura13, Toshio Tsuyuguchi14, Takao Itoi15, Toshifumi Gabata16, Ryota Higuchi17, Kohji Okamoto18, Jiro Hata19, Atsuhiko Murata20, Shinya Kusachi21, John A. Windsor22, Avinash N. Supe23, SungGyu Lee24, Xiao-Ping Chen25, Yuichi Yamashita26, Koichi Hirata27, Kazuo Inui28, Yoshinobu Sumiyama29
1Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
2Section of Hepatobiliary and Pancreatic Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, USA
3Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, USA
4Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
5Center for Clinical Infectious Diseases; Jichi Medical University; Tochigi Japan
6Clinical Research Center Kaken Hospital, International University of Health and Welfare, Ichikawa, Japan
7Department of Emergency and Critical Care Medicine, Ichinomiya Municipal Hospital, Ichinomiya, Japan
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
12General Internal Medicine, Nagoya Daini Red Cross Hospital, Nagoya, Japan
13Department of Surgical Oncology and Gastroenterological Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
14Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba , Japan
15Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
16Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
17Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
18Department of Surgery Kitakyushu Municipal Yahata Hospital Kitakyushu Japan
19Department of Endoscopy and Ultrasound, Kawasaki Medical School, Okayama, Japan
20Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
21Department of Surgery, Toho University Medical Center Ohashi Hospital, Tokyo, Japan
22Department of Surgery, The University of Auckland, Auckland, New Zealand
23Department of Surgical Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai, India
24HepatoBiliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University, Seoul, Korea
25Department of Surgery, Hepatic Surgery Centre, Tongji Hospital, Tongi Medical College, Huazhong Universty of Science & Technology, Wuhan, China
26Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
27Department of Internal Medicine, Second Teaching Hospital, Fujita Health University School of Medicine, Nagoya, Japan
28Department of Surgery I, Sapporo Medical University Hospital, Sapporo, Japan
29Toho University School of Medicine, Tokyo, Japan

Tóm tắt

In 2007, the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) were first published in the Journal of Hepato-Biliary-Pancreatic Surgery. The fundamental policy of TG07 was to achieve the objectives of TG07 through the development of consensus among specialists in this field throughout the world. Considering such a situation, validation and feedback from the clinicians’ viewpoints were indispensable. What had been pointed out from clinical practice was the low diagnostic sensitivity of TG07 for acute cholangitis and the presence of divergence between severity assessment and clinical judgment for acute cholangitis. In June 2010, we set up the Tokyo Guidelines Revision Committee for the revision of TG07 (TGRC) and started the validation of TG07. We also set up new diagnostic criteria and severity assessment criteria by retrospectively analyzing cases of acute cholangitis and cholecystitis, including cases of non-inflammatory biliary disease, collected from multiple institutions. TGRC held meetings a total of 35 times as well as international email exchanges with co-authors abroad. On June 9 and September 6, 2011, and on April 11, 2012, we held three International Meetings for the Clinical Assessment and Revision of Tokyo Guidelines. Through these meetings, the final draft of the updated Tokyo Guidelines (TG13) was prepared on the basis of the evidence from retrospective multi-center analyses. To be specific, discussion took place involving the revised new diagnostic criteria, and the new severity assessment criteria, new flowcharts of the management of acute cholangitis and cholecystitis, recommended medical care for which new evidence had been added, new recommendations for gallbladder drainage and antimicrobial therapy, and the role of surgical intervention. Management bundles for acute cholangitis and cholecystitis were introduced for effective dissemination with the level of evidence and the grade of recommendations. GRADE systems were utilized to provide the level of evidence and the grade of recommendations. TG13 improved the diagnostic sensitivity for acute cholangitis and cholecystitis, and presented criteria with extremely low false positive rates adapted for clinical practice. Furthermore, severity assessment criteria adapted for clinical use, flowcharts, and many new diagnostic and therapeutic modalities were presented. The bundles for the management of acute cholangitis and cholecystitis are presented in a separate section in TG13. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html .

Tài liệu tham khảo

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Journal of Hepato-Biliary-Pancreatic Sciences

Tập 20

1-7

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