Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines |
| |
Authors: | Fumihiko Miura Tadahiro Takada Yoshifumi Kawarada Yuji Nimura Keita Wada Masahiko Hirota Masato Nagino Toshio Tsuyuguchi Toshihiko Mayumi Masahiro Yoshida Steven M. Strasberg Henry A. Pitt Jacques Belghiti Eduardo de Santibanes Thomas R. Gadacz Dirk J. Gouma Sheung-Tat Fan Miin-Fu Chen Robert T. Padbury Philippus C. Bornman Sun-Whe Kim Kui-Hin Liau Giulio Belli Christos Dervenis |
| |
Affiliation: | Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8605, Japan Mie University School of Medicine, Mie, Japan Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Science, Kumamoto, Japan Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan Department of Emergency Medicine and Critical Care, Nagoya University School of Medicine, Nagoya, Japan Department of Surgery, Washington University in St Louis and Barnes-Jewish Hospital, St Louis, USA Department of Surgery, Indiana University School of Medicine, Indianapolis, USA Department of Digestive Surgery and Transplantation, Hospital Beaujon, Clichy, France Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina Department of Gastrointestinal Surgery, Medical College of Georgia, Georgia, USA Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan Division of Surgical and Specialty Services, Flinders Medical Centre, Adelaide, Australia Division of General Surgery, University of Cape Town, Cape Town, South Africa Department of Surgery, Seoul National University College of Medicine, Seoul, Korea Department of Surgery, Tan Tock Seng Hospital / Hepatobiliary Surgery, Medical Centre, Singapore, Singapore Department of General and Hepato-Pancreato-Biliary Surgery, S.M. Loreto Nuovo Hospital, Naples, Italy First Department of Surgery, Agia Olga Hospital, Athens, Greece
|
| |
Abstract: | Diagnostic and therapeutic strategies for acute biliary inflammation/infection (acute cholangitis and acute cholecystitis), according to severity grade, have not yet been established in the world. Therefore we formulated flowcharts for the management of acute biliary inflammation/infection in accordance with severity grade. For mild (grade I) acute cholangitis, medical treatment may be sufficient/appropriate. For moderate (grade II) acute cholangitis, early biliary drainage should be performed. For severe (grade III) acute cholangitis, appropriate organ support such as ventilatory/circulatory management is required. After hemodynamic stabilization is achieved, urgent endoscopic or percutaneous transhepatic biliary drainage should be performed. For patients with acute cholangitis of any grade of severity, treatment for the underlying etiology, including endoscopic, percutaneous, or surgical treatment should be performed after the patient’s general condition has improved. For patients with mild (grade I) cholecystitis, early laparoscopic cholecystectomy is the preferred treatment. For patients with moderate (grade II) acute cholecystitis, early laparoscopic or open cholecystectomy is preferred. In patients with extensive local inflammation, elective cholecystectomy is recommended after initial management with percutaneous gallbladder drainage and/or cholecystostomy. For the patient with severe (grade III) acute cholecystitis, multiorgan support is a critical part of management. Biliary peritonitis due to perforation of the gallbladder is an indication for urgent cholecystectomy and/or drainage. Delayed elective cholecystectomy may be performed after initial treatment with gallbladder drainage and improvement of the patient’s general medical condition. |
| |
Keywords: | Cholangitis Acute cholecystitis Cholecystec‐tomy Laparoscopic cholecystectomy Biliary Drainage Guidelines |
本文献已被 SpringerLink 等数据库收录! |
|