Background: Tokyo Guidelines for the management of acute cholangitis and cholecystitis |
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| Authors: | Takada Tadahiro Kawarada Yoshifumi Nimura Yuji Yoshida Masahiro Mayumi Toshihiko Sekimoto Miho Miura Fumihiko Wada Keita Hirota Masahiko Yamashita Yuichi Nagino Masato Tsuyuguchi Toshio Tanaka Atsushi Kimura Yasutoshi Yasuda Hideki Hirata Koichi Pitt Henry A Strasberg Steven M Gadacz Thomas R Bornman Philippus C Gouma Dirk J Belli Giulio Liau Kui-Hin |
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| Affiliation: | (1) Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan;(2) Mie University School of Medicine, Mie, Japan;(3) Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan;(4) Department of Emergency Medicine and Intensive Care, Nagoya University School of Medicine, Nagoya, Japan;(5) Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan;(6) Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Science, Kumamoto, Japan;(7) Department of Surgery, Fukuoka University Hospital, Fukuoka, Japan;(8) Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan;(9) Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan;(10) First Department of Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan;(11) Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan;(12) Department of Surgery, Indiana University School of Medicine, Indianapolis, USA;(13) Department of Surgery, Washington University in St Louis and Barnes-Jewish Hospital, St Louis, USA;(14) Department of Gastrointestinal Surgery, Medical College of Georgia, Georgia, USA;(15) Division of General Surgery, University of Cape Town, Cape Town, South Africa;(16) Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands;(17) General and HPB Surgery, Loreto Nuovo Hospital, Naples, Italy;(18) Department of Surgery, Tan Tock Seng Hospital / Hepatobiliary Surgery, Medical Centre, Singapore, Singapore |
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| Abstract: | There are no evidence-based-criteria for the diagnosis, severity assessment, of treatment of acute cholecysitis or acute cholangitis. For example, the full complement of symptoms and signs described as Charcot's triad and as Reynolds' pentad are infrequent and as such do not really assist the clinician with planning management strategies. In view of these factors, we launched a project to prepare evidence-based guidelines for the management of acute cholangitis and cholecystitis that will be useful in the clinical setting. This research has been funded by the Japanese Ministry of Health, Labour, and Welfare, in cooperation with the Japanese Society for Abdominal Emergency Medicine, the Japan Biliary Association, and the Japanese Society of Hepato-Biliary-Pancreatic Surgery. A working group, consisting of 46 experts in gastroenterology, surgery, internal medicine, emergency medicine, intensive care, and clinical epidemiology, analyzed and examined the literature on patients with cholangitis and cholecystitis in order to produce evidence-based guidelines. During the investigations we found that there was a lack of high-level evidence, for treatments, and the working group formulated the guidelines by obtaining consensus, based on evidence categorized by level, according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence of May 2001 (version 1). This work required more than 20 meetings to obtain a consensus on each item from the working group. Then four forums were held to permit examination of the Guideline details in Japan, both by an external assessment committee and by the working group participants (version 2). As we knew that the diagnosis and management of acute biliary infection may differ from country to country, we appointed a publication committee and held 12 meetings to prepare draft Guidelines in English (version 3). We then had several discussions on these draft guidelines with leading experts in the field throughout the world, via e-mail, leading to version 4. Finally, an International Consensus Meeting took place in Tokyo, on 1–2 April, 2006, to obtain international agreement on diagnostic criteria, severity assessment, and management. |
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| Keywords: | Cholangitis Cholecystitis Charcot's triad Reynold's pentad Biliary drainage |
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