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

Journal of Hepato-Biliary-Pancreatic Sciences, Jan 2013

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

Masamichi Yokoe 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Tadahiro Takada 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Steven M. Strasberg 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Joseph S. Solomkin 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Toshihiko Mayumi 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Harumi Gomi 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Henry A. Pitt 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 O. James Garden 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Seiki Kiriyama 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Jiro Hata 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Toshifumi Gabata 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Masahiro Yoshida 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Fumihiko Miura 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Kohji Okamoto 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Toshio Tsuyuguchi 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Takao Itoi 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Yuichi Yamashita 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Christos Dervenis 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Angus C. W. Chan 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Wan-Yee Lau 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Avinash N. Supe 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Giulio Belli 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Serafin C. Hilvano 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Kui-Hin Liau 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Myung-Hwan Kim 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Sun-Whe Kim 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Chen-Guo Ker 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 0 M. Yoshida Clinical Research Center Kaken Hospital, International University of Health and Welfare , Ichikawa, Japan 1 S. M. Strasberg Section of Hepatobiliary and Pancreatic Surgery, Washington University in Saint Louis School of Medicine , Saint Louis, MO, USA 2 T. Gabata Department of Radiology, Kanazawa University Graduate School of Medical Science , Kanazawa, Japan 3 T. Takada F. Miura Department of Surgery, Teikyo University School of Medicine , Tokyo, Japan 4 M. Yokoe (&) General Internal Medicine, Nagoya Daini Red Cross Hospital , 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi 466-8650, Japan 5 J. Hata Department of Endoscopy and Ultrasound, Kawasaki Medical School , Okayama, Japan 6 S. Kiriyama Department of Gastroenterology, Ogaki Municipal Hospital , Ogaki, Japan 7 O. J. Garden Clinical Surgery, The University of Edinburgh , Edinburgh, UK 8 H. A. Pitt Department of Surgery, Indiana University School of Medicine , Indianapolis, IN, USA 9 H. Gomi Center for Clinical Infectious Diseases, Jichi Medical University , Tochigi, Japan 10 T. Mayumi Department of Emergency and Critical Care Medicine, Ichinomiya Municipal Hospital , Ichinomiya, Japan 11 J. S. Solomkin Department of Surgery, University of Cincinnati College of Medicine , Cincinnati, OH, USA 12 T. Itoi Department of Gastroenterology and Hepatology, Tokyo Medical University , Tokyo, Japan 13 M.-H. Kim Department of Internal Medicine, Asan Medical Center, University of Ulsan , Seoul, Korea 14 T. Tsuyuguchi Department of Medicine and Clinical Oncology, Graduate School of Medicine Chiba University , Chiba, Japan 15 K.-H. Liau Hepatobiliary and Pancreatic Surgery, Nexus Surgical Associates, Mount Elizabeth Hospital , Singapore, Singapore 16 C.-G. Ker Yuan's General Hospital , Kaohsiung, Taiwan 17 K. Okamoto Department of Surgery, Kitakyushu Municipal Yahata Hospital , Kitakyushu, Japan 18 S.-W. Kim Department of Surgery, Seoul National University College of Medicine , Seoul, Korea 19 S. C. Hilvano Department of Surgery, College of Medicine-Philippine General Hospital, University of the Philippines , Manila, Philippines 20 G. Belli General and HPB Surgery, Loreto Nuovo Hospital , Naples, Italy 21 A. N. Supe Department of Surgical Gastroenterology, Seth G S Medical College and K E M Hospital , Mumbai, India 22 W.-Y. Lau Faculty of Medicine, The Chinese University of Hong Kong , Hong Kong, Hong Kong 23 A. C. W. Chan Department of Surgery, Surgery Centre, Hong Kong Sanatorium and Hospital , Hong Kong, Hong Kong 24 C. Dervenis First Department of Surgery, Agia Olga Hospital , Athens, Greece 25 Y. Yamashita Department of Gastroenterological Surgery, Fukuoka University School of Medicine , Fukuoka, Japan Since its publication in 2007, the Tokyo Guideline (...truncated)


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Masamichi Yokoe, Tadahiro Takada, Steven M. Strasberg, Joseph S. Solomkin, Toshihiko Mayumi, Harumi Gomi, Henry A. Pitt, O. James Garden, Seiki Kiriyama, Jiro Hata, Toshifumi Gabata, Masahiro Yoshida, Fumihiko Miura, Kohji Okamoto, Toshio Tsuyuguchi, Takao Itoi, Yuichi Yamashita, Christos Dervenis, Angus C. W. Chan, Wan-Yee Lau, Avinash N. Supe, Giulio Belli, Serafin C. Hilvano, Kui-Hin Liau, Myung-Hwan Kim, Sun-Whe Kim, Chen-Guo Ker. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos), Journal of Hepato-Biliary-Pancreatic Sciences, 2013, pp. 35-46, Volume 20, Issue 1, DOI: 10.1007/s00534-012-0568-9