TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis

Journal of Hepato-Biliary-Pancreatic Sciences, Jan 2013

In 2007, the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) were first published in the Journal of Hepato-Biliary-Pancreatic Surgery. The fundamental policy of TG07 was to achieve the objectives of TG07 through the development of consensus among specialists in this field throughout the world. Considering such a situation, validation and feedback from the clinicians’ viewpoints were indispensable. What had been pointed out from clinical practice was the low diagnostic sensitivity of TG07 for acute cholangitis and the presence of divergence between severity assessment and clinical judgment for acute cholangitis. In June 2010, we set up the Tokyo Guidelines Revision Committee for the revision of TG07 (TGRC) and started the validation of TG07. We also set up new diagnostic criteria and severity assessment criteria by retrospectively analyzing cases of acute cholangitis and cholecystitis, including cases of non-inflammatory biliary disease, collected from multiple institutions. TGRC held meetings a total of 35 times as well as international email exchanges with co-authors abroad. On June 9 and September 6, 2011, and on April 11, 2012, we held three International Meetings for the Clinical Assessment and Revision of Tokyo Guidelines. Through these meetings, the final draft of the updated Tokyo Guidelines (TG13) was prepared on the basis of the evidence from retrospective multi-center analyses. To be specific, discussion took place involving the revised new diagnostic criteria, and the new severity assessment criteria, new flowcharts of the management of acute cholangitis and cholecystitis, recommended medical care for which new evidence had been added, new recommendations for gallbladder drainage and antimicrobial therapy, and the role of surgical intervention. Management bundles for acute cholangitis and cholecystitis were introduced for effective dissemination with the level of evidence and the grade of recommendations. GRADE systems were utilized to provide the level of evidence and the grade of recommendations. TG13 improved the diagnostic sensitivity for acute cholangitis and cholecystitis, and presented criteria with extremely low false positive rates adapted for clinical practice. Furthermore, severity assessment criteria adapted for clinical use, flowcharts, and many new diagnostic and therapeutic modalities were presented. The bundles for the management of acute cholangitis and cholecystitis are presented in a separate section in TG13. 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: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis

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 26 27 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 26 27 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 26 27 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 26 27 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 26 27 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 26 27 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 26 27 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 26 27 Dirk J. Gouma 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 26 27 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 26 27 Markus W. Bu chler 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 26 27 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 26 27 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 26 27 Yasutoshi Kimura 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 26 27 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 26 27 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 26 27 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 26 27 Ryota Higuchi 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 26 27 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 26 27 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 26 27 Atsuhiko Murata 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 26 27 Shinya Kusachi 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 26 27 John A. Windsor 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 26 27 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 26 27 SungGyu Lee 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 26 27 Xiao-Ping Chen 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 26 27 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 26 27 Koichi Hirata 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 26 27 Kazuo Inui 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 26 27 Yoshinobu Sumiyama 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 26 27 0 J. S. Solomkin Department of Surgery, University of Cincinnati College of Medicine , Cincinnati, OH, USA 1 M. Yokoe General Internal Medicine, Nagoya Daini Red Cross Hospital , Nagoya, Japan 2 S. M. Strasberg Section of Hepatobiliary and Pancreatic Surgery, Washington University in Saint Louis School of Medicine , Saint Louis, MO, USA 3 S. Kiriyama Department of Gastroenterology, Ogaki Municipal Hospital , Ogaki, Japan 4 T. Tsuyuguchi Department of Medicine and Clinical Oncology, Graduate School of Medicine Chiba University , Chiba, Japan 5 T. Takada (&) F. Miura Department of Surgery, Teikyo University School of Medicine , 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan 6 Y. Kimura Department of Surgical Oncology and Gastroenterological Surgery, Sapporo Medical University School of Medicine , Sapporo, Japan 7 M. W. Buchler Department of Surgery, University of Heidelberg , Heidelberg, Germany 8 O. J. Garden Clinical Surgery, The University of Edinburgh , Edinburgh, UK 9 D. J. Gouma Department of Surgery, Academic Medical Center , Amsterdam, The Netherlands 10 T. Mayumi Department of Emergency and Critical Care Medicine, Ichinomiya Municipal Hospital , Ichinomiya, Japan 11 M. Yoshida Clinical Research Center Kaken Hospital, International University of Health and Welfare , Ichikawa, Japan 12 H. Gomi Center for Clinical Infectious Diseases, Jichi Medical University , Tochigi, Japan 13 H. A. Pitt Department of Surgery, Indiana University School of Medicine , Indianapolis, IN, USA 14 R. Higuchi Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University , Tokyo, Japan 15 K. Hirata Department of Internal Medicine, Second Teaching Hospital, Fujita Health University School of Medicine , Nagoya, Aichi, Japan 16 T. Gabata Department of Radiology, Kanazawa University Graduate School of Medical Science , Kanazawa, Japan 17 Y. Yamashita Department of Gastroenterological Surgery, Fukuoka University School of Medicine , Fukuoka, Japan 18 Y. Sumiyama Toho University School of Medicine , Tokyo, Japan 19 T. Itoi Department of Gastroenterology and Hepatology, Tokyo Medical University , Tokyo, Japan 20 K. Inui Department of Surgery I, Sapporo Medical University Hospital , Sapporo, Hokkaido, Japan 21 X.-P. Chen Department of Surgery, Hepatic Surgery Centre, Tongji Hosp (...truncated)


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Tadahiro Takada, Steven M. Strasberg, Joseph S. Solomkin, Henry A. Pitt, Harumi Gomi, Masahiro Yoshida, Toshihiko Mayumi, Fumihiko Miura, Dirk J. Gouma, O. James Garden, Markus W. Büchler, Seiki Kiriyama, Masamichi Yokoe, Yasutoshi Kimura, Toshio Tsuyuguchi, Takao Itoi, Toshifumi Gabata, Ryota Higuchi, Kohji Okamoto, Jiro Hata, Atsuhiko Murata, Shinya Kusachi, John A. Windsor, Avinash N. Supe, SungGyu Lee, Xiao-Ping Chen, Yuichi Yamashita, Koichi Hirata, Kazuo Inui, Yoshinobu Sumiyama. TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis, Journal of Hepato-Biliary-Pancreatic Sciences, 2013, pp. 1-7, Volume 20, Issue 1, DOI: 10.1007/s00534-012-0566-y