Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis

Journal of Hepato-Biliary-Pancreatic Sciences - Tập 25 Số 1 - Trang 31-40 - 2018
Fumihiko Miura1, Kohji Okamoto2, Tadahiro Takada1, Steven M. Strasberg3, Horacio J. Asbun4, Henry A. Pitt5, Harumi Gomi6, Joseph S. Solomkin7, David Schlossberg5, Ho‐Seong Han8, Myung‐Hwan Kim9, Tsann‐Long Hwang10, Miin‐Fu Chen11, Wayne Shih‐Wei Huang11, Seiki Kiriyama12, Takao Itoi13, O. James Garden14, Kui‐Hin Liau15, Akihiko Horiguchi16, Keng‐Hao Liu11, Cheng‐Hsi Su17, Dirk J. Gouma18, Giulio Belli19, Christos Dervenis20, P. Jagannath21, Annie On On Chan22, Wan Yee Lau23, Itaru Endo24, Kenji Suzuki25, Yoo‐Seok Yoon8, Eduardo de Santibáñes26, Mariano Giménez27, Eduard Jonas28, Harjit Singh29, Goro Honda30, Koji Asai31, Yasuhisa Mori32, Kei Nakagawa1, Ryota Higuchi33, Manabu Watanabe31, Toshiki Rikiyama34, Naohiro Sata35, Nobuyasu Kano36, Akiko Umezawa37, Shuntaro Mukai13, Hiromi Takeuchi38, Jiro Hata39, Kazuto Kozaka40, Yukio Iwashita41, Taizo Hibi42, Masamichi Yokoe43, Taizo Kimura25, Seigo Kitano44, Masafumi Inomata41, Koichi Hirata45, Yoshinobu Sumiyama46, Kazuo Inui47, Masakazu Yamamoto33
1Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
2Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Fukuoka, Japan
3Section of Hepato-Pancreato-Biliary Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
4Department of Surgery, Mayo Clinic College of Medicine, Jacksonville, FL, USA
5Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
6Center for Global Health, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan
7Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
8Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
9Department of Gastroenterology, University of Ulsan College of Medicine, Seoul, Korea
10Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
11Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan
12Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan
13Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
14Clinical Surgery, University of Edinburgh, Edinburgh, UK
15Liau KH Consulting PL, Mt Elizabeth Novena Hospital, Singapore and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
16Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Aichi, Japan
17Department of Surgery, Cheng Hsin General Hospital, Taipei, Taiwan
18Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
19Department of General and HPB Surgery, Loreto Nuovo Hospital, Naples, Italy
20First Department of Surgery, Agia Olga Hospital, Athens, Greece
21Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, India
22Surgery Centre, Department of Surgery, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong
23Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
24Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
25Department of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan
26Department of Surgery, Hospital Italiano, University of Buenos Aires, Buenos Aires, Argentina
27Chair of General Surgery and Minimal Invasive Surgery “Taquini” University of Buenos Aires DAICIM Foundation Buenos Aires Argentina
28Surgical Gastroenterology/Hepatopancreatobiliary Unit, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
29Department of Hepato-Pancreato-Biliary Surgery, Hospital Selayang, Selangor, Malaysia
30Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
31Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
32Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
33Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
34Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
35Department of Surgery, Jichi Medical University, Tochigi, Japan
36Director, Chiba Tokushukai Hospital, Chiba, Japan
37Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
38Department of Surgery, Tohoku Rosai Hospital, Miyagi, Japan
39Department of Endoscopy and Ultrasound, Kawasaki Medical School, Okayama, Japan
40Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
41Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
42Department of Surgery, Keio University School of Medicine, Tokyo, Japan
43Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
44President, Oita University, Oita, Japan
45Department of Surgery, JR Sapporo Hospital, Hokkaido, Japan
46Director, Toho University, Tokyo, Japan
47Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, Aichi, Japan

Tóm tắt

AbstractThe initial management of patients with suspected acute biliary infection starts with the measurement of vital signs to assess whether or not the situation is urgent. If the case is judged to be urgent, initial medical treatment should be started immediately including respiratory/circulatory management if required, without waiting for a definitive diagnosis. The patient's medical history is then taken; an abdominal examination is performed; blood tests, urinalysis, and diagnostic imaging are carried out; and a diagnosis is made using the diagnostic criteria for cholangitis/cholecystitis. Once the diagnosis has been confirmed, initial medical treatment should be started immediately, severity should be assessed according to the severity grading criteria for acute cholangitis/cholecystitis, and the patient's general status should be evaluated. For mild acute cholangitis, in most cases initial treatment including antibiotics is sufficient, and most patients do not require biliary drainage. However, biliary drainage should be considered if a patient does not respond to initial treatment. For moderate acute cholangitis, early endoscopic or percutaneous transhepatic biliary drainage is indicated. If the underlying etiology requires treatment, this should be provided after the patient's general condition has improved; endoscopic sphincterotomy and subsequent choledocholithotomy may be performed together with biliary drainage. For severe acute cholangitis, appropriate respiratory/circulatory management is required. Biliary drainage should be performed as soon as possible after the patient's general condition has been improved by initial treatment and respiratory/circulatory management. 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.

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Journal of Hepato-Biliary-Pancreatic Sciences

Tập 25 Số 1

31-40

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