TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos)

Journal of Hepato-Biliary-Pancreatic Sciences - Tập 20 Số 1 - Trang 35-46 - 2013
Masamichi Yokoe1, Tadahiro Takada2, Steven M. Strasberg3, Joseph S. Solomkin4, Toshihiko Mayumi5, Harumi Gomi6, Henry A. Pitt, O. James Garden7, Seiki Kiriyama8, Jiro Hata9, Toshifumi Gabata10, Masahiro Yoshida11, Fumihiko Miura2, Kohji Okamoto12, Toshio Tsuyuguchi13, Takao Itoi14, Yuichi Yamashita15, Christos Dervenis16, Annie On On Chan17, Wan Yee Lau18, Avinash Supe19, Giulio Belli20, Serafin C. Hilvano21, Kui Hin Liau22, Myung Hwan Kim23, Sun Whe Kim24, Chen Guo Ker25
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
7Clinical Surgery, The University of Edinburgh, Edinburgh, UK
8Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
9Department of Endoscopy and Ultrasound, Kawasaki Medical School, Okayama, Japan
10Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
11Clinical Research Center Kaken Hospital, International University of Health and Welfare, Ichikawa, Japan
12Department of Surgery Kitakyushu Municipal Yahata Hospital Kitakyushu 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
15Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
16First Department of Surgery, Agia Olga Hospital, Athens, Greece
17Department of Surgery, Surgery Centre, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong
18Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
19Department of Surgical Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai, India
20General and HPB Surgery, Loreto Nuovo Hospital, Naples, Italy
21Department of Surgery, College of Medicine-Philippine General Hospital, University of the Philippines, Manila, Philippines
22Hepatobiliary and Pancreatic Surgery, Nexus Surgical Associates, Mount Elizabeth Hospital, Singapore, Singapore
23Department of Internal Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
24Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
25Yuan’s general hospital, Kaohsiung, Taiwan

Tóm tắt

AbstractSince its publication in 2007, the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) have been widely adopted. The validation of TG07 conducted in terms of clinical practice has shown that the diagnostic criteria for acute cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. Discussion by the Tokyo Guidelines Revision Committee concluded that acute cholecystitis should be suspected when Murphy's sign, local inflammatory findings in the gallbladder such as right upper quadrant abdominal pain and tenderness, and fever and systemic inflammatory reaction findings detected by blood tests are present but that definite diagnosis of acute cholecystitis can be made only on the basis of the imaging of ultrasonography, computed tomography or scintigraphy (HIDA scan). These proposed diagnostic criteria provided better specificity and accuracy rates than the TG07 diagnostic criteria. As for the severity assessment criteria in TG07, there is evidence that TG07 resulted in clarification of the concept of severe acute cholecystitis. Furthermore, there is evidence that severity assessment in TG07 has led to a reduction in the mean duration of hospital stay. As for the factors used to establish a moderate grade of acute cholecystitis, such as leukocytosis, ALP, old age, diabetes, being male, and delay in admission, no new strong evidence has been detected indicating that a change in the criteria used in TG07 is needed. Therefore, it was judged that the severity assessment criteria of TG07 could be applied in the updated Tokyo Guidelines (TG13) with minor changes. TG13 presents new standards for the diagnosis, severity grading and management of acute cholecystitis.

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Journal of Hepato-Biliary-Pancreatic Sciences

Tập 20 Số 1

35-46

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