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J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):41-54. doi: 10.1002/jhbp.515. Epub 2018 Jan 9.

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

Author information

1
Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan.
2
Department of Endoscopy and Ultrasound, Kawasaki Medical School, Okayama, Japan.
3
Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
4
Section of Hepato-Pancreato-Biliary Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
5
Department of Surgery, Mayo Clinic College of Medicine, Jacksonville, FL, USA.
6
Department of Surgery, Ageo Central General Hospital, Saitama, Japan.
7
Department of Radiology, Kanazawa University, Graduate School of Medical Sciences, Ishikawa, Japan.
8
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.
9
Department of Surgery, Rush University Medical Center, Chicago, IL, USA.
10
Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Fukuoka, Japan.
11
Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
12
Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan.
13
Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan.
14
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
15
Department of Surgery, Konyang University Hospital, Daejeon, Korea.
16
Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Korea.
17
Mie Prefectural Ichishi Hospital, Mie, Japan.
18
Department of Family Medicine, Mie Prefectural Ichishi Hospital, Mie, Japan.
19
Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
20
Kanazawa University Hospital, Ishikawa, Japan.
21
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
22
Department of Gastroenterological and Pediatric Surgery, Oita University, Faculty of Medicine, Oita, Japan.
23
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
24
Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, India.
25
Surgical Gastroenterology/Hepatopancreatobiliary Unit, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
26
Mt Elizabeth Novena Hospital, Singapore Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
27
First Department of Surgery, Agia Olga Hospital, Athens, Greece.
28
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
29
Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France.
30
Department of General and HPB Surgery, Loreto Nuovo Hospital, Naples, Italy.
31
Clinical Surgery, University of Edinburgh, Edinburgh, UK.
32
Chair of General Surgery and Minimal Invasive Surgery "Taquini", University of Buenos Aires, DAICIM Foundation, Buenos Aires, Argentina.
33
Department of Surgery, Hospital Italiano, University of Buenos Aires, Buenos Aires, Argentina.
34
Department of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan.
35
Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan.
36
Department of Surgical Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai, India.
37
Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
38
Department of Hepato-Pancreato-Biliary Surgery, Hospital Selayang, Selangor, Malaysia.
39
Surgery Centre, Department of Surgery, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong.
40
Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
41
Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong.
42
Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
43
Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan.
44
Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan.
45
Center for Global Health, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan.
46
Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan.
47
Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan.
48
Department of Hemodialysis and Surgery, Chemotherapy Research Institute Kaken Hospital, International University of Health and Welfare, Chiba, Japan.
49
Department of EBM and Guidelines, Japan Council for Quality Health Care, Tokyo, Japan.
50
Department of Surgery, Tohoku Rosai Hospital, Miyagi, Japan.
51
Oita University, Oita, Japan.
52
Department of Surgery, JR Sapporo Hospital, Hokkaido, Japan.
53
Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, Aichi, Japan.
54
Toho University, Tokyo, Japan.

Abstract

The Tokyo Guidelines 2013 (TG13) for acute cholangitis and cholecystitis were globally disseminated and various clinical studies about the management of acute cholecystitis were reported by many researchers and clinicians from all over the world. The 1st edition of the Tokyo Guidelines 2007 (TG07) was revised in 2013. According to that revision, the TG13 diagnostic criteria of acute cholecystitis provided better specificity and higher diagnostic accuracy. Thorough our literature search about diagnostic criteria for acute cholecystitis, new and strong evidence that had been released from 2013 to 2017 was not found with serious and important issues about using TG13 diagnostic criteria of acute cholecystitis. On the other hand, the TG13 severity grading for acute cholecystitis has been validated in numerous studies. As a result of these reviews, the TG13 severity grading for acute cholecystitis was significantly associated with parameters including 30-day overall mortality, length of hospital stay, conversion rates to open surgery, and medical costs. In terms of severity assessment, breakthrough and intensive literature for revising severity grading was not reported. Consequently, TG13 diagnostic criteria and severity grading were judged from numerous validation studies as useful indicators in clinical practice and adopted as TG18/TG13 diagnostic criteria and severity grading of acute cholecystitis without any modification. 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; Cholecystitis; Diagnosis; Diagnostic imaging; Guidelines; Severity of Illness Index

PMID:
29032636
DOI:
10.1002/jhbp.515
[Indexed for MEDLINE]
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