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Verification of Tokyo Guidelines for diagnosis and management of acute cholangitis.
MedLine Citation:
PMID:  22033865     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: This study aimed to verify diagnostic criteria and severity assessment of the Tokyo Guidelines for acute cholangitis. METHODS: We re-examined whether acute cholangitis was concomitant with gallstones according to the Tokyo Guidelines in 248 patients with choledocholithiasis. Our conventional diagnoses based on physician decision were compared with diagnoses from the Tokyo Guidelines. Problems with severity grade criteria were also evaluated. RESULTS: In total, 53 cases of acute cholangitis were determined by using the Tokyo Guidelines, including three false-negative and seven false-positive cases (acute cholecystitis or pancreatitis was concomitant with choledocholithiasis). Sensitivity, specificity, and accuracy were 94%, 96%, and 96%, respectively. Forty of the 53 patients underwent biliary drainage (mean interval between admission and drainage, 1.4 days). Severity grades were mild in 10, moderate in 30, and severe in 13 patients. Of these 13 patients with severe disease, 2 had chronic renal failure, 1 had liver cirrhosis, and 1 had severe acute pancreatitis and liver cirrhosis. No patients died, irrespective of severity grade. CONCLUSIONS: Acute cholangitis should be carefully diagnosed when other inflammatory disease is concomitant with choledocholithiasis. A few patients have absolute acute cholangitis even when they do not meet Tokyo Guidelines diagnostic criteria. Classification into mild or moderate grade using the Tokyo Guidelines is difficult when early biliary drainage is routinely performed. When determining severity grade, clinicians must distinguish between organ dysfunction associated with cholangitis itself and that associated with the underlying/concomitant disease. Apart from a few problems like these, the Tokyo Guidelines are mostly acceptable for the diagnosis and management of acute cholangitis.
Authors:
Yoshiro Fujii; Jiro Ohuchida; Kazuo Chijiiwa; Koichi Yano; Naoya Imamura; Motoaki Nagano; Masahide Hiyoshi; Kazuhiro Otani; Masahiro Kai; Kazuhiro Kondo
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-10-28
Journal Detail:
Title:  Journal of hepato-biliary-pancreatic sciences     Volume:  -     ISSN:  1868-6982     ISO Abbreviation:  -     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101528587     Medline TA:  J Hepatobiliary Pancreat Sci     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Surgical Oncology and Regulation of Organ Function, Miyazaki University, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
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