Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jan;25(1):17-30.
doi: 10.1002/jhbp.512. Epub 2018 Jan 5.

Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)

Seiki Kiriyama  1 , Kazuto Kozaka  2 , Tadahiro Takada  3 , Steven M Strasberg  4 , Henry A Pitt  5 , Toshifumi Gabata  6 , Jiro Hata  7 , Kui-Hin Liau  8 , Fumihiko Miura  3 , Akihiko Horiguchi  9 , Keng-Hao Liu  10 , Cheng-Hsi Su  11 , Keita Wada  3 , Palepu Jagannath  12 , Takao Itoi  13 , Dirk J Gouma  14 , Yasuhisa Mori  15 , Shuntaro Mukai  13 , Mariano Eduardo Giménez  16   17 , Wayne Shih-Wei Huang  18 , Myung-Hwan Kim  19 , Kohji Okamoto  20 , Giulio Belli  21 , Christos Dervenis  22 , Angus C W Chan  23 , Wan Yee Lau  24 , Itaru Endo  25 , Harumi Gomi  26 , Masahiro Yoshida  27   28 , Toshihiko Mayumi  29 , Todd H Baron  30 , Eduardo de Santibañes  31 , Anthony Yuen Bun Teoh  32 , Tsann-Long Hwang  10 , Chen-Guo Ker  33 , Miin-Fu Chen  10 , Ho-Seong Han  34 , Yoo-Seok Yoon  34 , In-Seok Choi  35 , Dong-Sup Yoon  36 , Ryota Higuchi  37 , Seigo Kitano  38 , Masafumi Inomata  39 , Daniel J Deziel  40 , Eduard Jonas  41 , Koichi Hirata  42 , Yoshinobu Sumiyama  43 , Kazuo Inui  44 , Masakazu Yamamoto  36
Affiliations

Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)

Seiki Kiriyama et al. J Hepatobiliary Pancreat Sci. 2018 Jan.

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.

Keywords: Acute cholangitis; Diagnostic criteria; Diagnostic imaging; Guidelines; Severity grading.

PubMed Disclaimer

Comment in

LinkOut - more resources