TG13 management bundles for acute cholangitis and cholecystitis

Journal of Hepato-Biliary-Pancreatic Sciences, Jan 2013

Bundles that define mandatory items or procedures to be performed in clinical practice have been increasingly used in guidelines in recent years. Observance of bundles enables improvement of the prognosis of target diseases as well as guideline preparation. There were no bundles adopted in the Tokyo Guidelines 2007, but the updated Tokyo Guidelines 2013 (TG13) have adopted this useful tool. Items or procedures strongly recommended in clinical practice have been prepared in the practical guidelines and presented as management bundles. TG13 defined the mandatory items for the management of acute cholangitis and acute cholecystitis. Critical parts of the bundles in TG13 include diagnostic process, severity assessment, transfer of patients if necessary, therapeutic approach, and time course. Their observance should improve the prognosis of acute cholangitis and cholecystitis. When utilizing TG13 management bundles, further clinical research needs to be conducted to evaluate the effectiveness and outcomes of the bundles. It is also expected that the present report will lead to evidence construction and contribute to further updating of the Tokyo Guidelines. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.

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TG13 management bundles for acute cholangitis and cholecystitis

Kohji Okamoto 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Tadahiro Takada 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Steven M. Strasberg 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Joseph S. Solomkin 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Henry A. Pitt 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 O. James Garden 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Markus W. Bu chler 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Masahiro Yoshida 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Fumihiko Miura 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Yasutoshi Kimura 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Ryota Higuchi 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Yuichi Yamashita 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Toshihiko Mayumi 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Harumi Gomi 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Shinya Kusachi 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Seiki Kiriyama 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Masamichi Yokoe 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Wan-Yee Lau 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Myung-Hwan Kim 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 T. Mayumi Department of Emergency and Critical Care Medicine, Ichinomiya Municipal Hospital , Ichinomiya, Japan 1 S. M. Strasberg Section of Hepatobiliary and Pancreatic Surgery, Washington University in Saint Louis School of Medicine , Saint Louis, MO, USA 2 Y. Yamashita Department of Gastroenterological Surgery, Fukuoka University School of Medicine , Fukuoka, Japan 3 T. Takada F. Miura Department of Surgery, Teikyo University School of Medicine , Tokyo, Japan 4 K. Okamoto (&) Department of Surgery, Kitakyushu Municipal Yahata Hospital , 4-18-1 Nishihon-machi, Yahatahigashi-ku, Kitakyushu, Fukuoka 805-8534, Japan 5 R. Higuchi Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University , Tokyo, Japan 6 Y. Kimura Department of Surgical Oncology and Gastroenterological Surgery, Sapporo Medical University School of Medicine , Sapporo, Japan 7 M. Yoshida Clinical Research Center Kaken Hospital, International University of Health and Welfare , Ichikawa, Japan 8 M. W. Buchler Department of Surgery, University of Heidelberg , Heidelberg, Germany 9 O. J. Garden Clinical Surgery, The University of Edinburgh , Edinburgh, UK 10 H. A. Pitt Department of Surgery, Indiana University School of Medicine , Indianapolis, IN, USA 11 J. S. Solomkin Department of Surgery, University of Cincinnati College of Medicine , Cincinnati, OH, USA 12 M. Yokoe General Internal Medicine Nagoya Daini Red Cross Hospital , Nagoya, Japan 13 S. Kiriyama Department of Gastroenterology, Ogaki Municipal Hospital , Ogaki, Japan 14 H. Gomi Center for Clinical Infectious Diseases, Jichi Medical University , Tochigi, Japan 15 M.-H. Kim Department of Internal Medicine, Asan Medical Center, University of Ulsan , Seoul, Korea 16 W.-Y. Lau Faculty of Medicine, The Chinese University of Hong Kong , Shatin, Hong Kong Bundles that define mandatory items or procedures to be performed in clinical practice have been increasingly used in guidelines in recent years. Observance of bundles enables improvement of the prognosis of target diseases as well as guideline preparation. There were no bundles adopted in the Tokyo Guidelines 2007, but the updated Tokyo Guidelines 2013 (TG13) have adopted this useful tool. Items or procedures strongly recommended in clinical practice have been prepared in the practical guidelines and presented as management bundles. TG13 defined the mandatory items for the management of acute cholangitis and acute cholecystitis. Critical parts of the bundles in TG13 include diagnostic process, severity assessment, transfer of patients if necessary, therapeutic approach, and time course. Their observance should improve the prognosis of acute cholangitis and cholecystitis. When utilizing TG13 management bundles, further clinical research needs to be conducted to evaluate the effectiveness and outcomes of the bundles. It is also expected that the present report will lead to evidence construction and contribute to further updating of the Tokyo Guidelines. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html. - A bundle is a group of therapies for a disease that, when implemented together, may result in better outcomes than if implemented individually. In recent years, bundles that define mandatory items or procedures to be performed in clinical practice have been increasingly used in guidelines [1]. Compliance with bundles results in the preparation of guidelines as well as an improved prognosis of targeted diseases arising from the use of the guidelines [2, 3]. Levy et al. [4] reported that data from 15,022 subjects at 165 sites were analyzed to determine compliance with bundle targets and association with hospital mortality, and compliance with the entire resuscitation bundle increased linearly from 10.9 % in the first site quarter to 31.3 % by the end of 2 years. Furthermore the odds rati (...truncated)


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Kohji Okamoto, Tadahiro Takada, Steven M. Strasberg, Joseph S. Solomkin, Henry A. Pitt, O. James Garden, Markus W. Büchler, Masahiro Yoshida, Fumihiko Miura, Yasutoshi Kimura, Ryota Higuchi, Yuichi Yamashita, Toshihiko Mayumi, Harumi Gomi, Shinya Kusachi, Seiki Kiriyama, Masamichi Yokoe, Wan-Yee Lau, Myung-Hwan Kim. TG13 management bundles for acute cholangitis and cholecystitis, Journal of Hepato-Biliary-Pancreatic Sciences, 2013, pp. 55-59, Volume 20, Issue 1, DOI: 10.1007/s00534-012-0562-2