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著者: Seiki Kiriyama, Kazuto Kozaka, Tadahiro Takada, Steven M Strasberg, Henry A Pitt, Toshifumi Gabata, Jiro Hata, Kui-Hin Liau, Fumihiko Miura, Akihiko Horiguchi, Keng-Hao Liu, Cheng-Hsi Su, Keita Wada, Palepu Jagannath, Takao Itoi, Dirk J Gouma, Yasuhisa Mori, Shuntaro Mukai, Mariano Eduardo Giménez, Wayne Shih-Wei Huang, Myung-Hwan Kim, Kohji Okamoto, Giulio Belli, Christos Dervenis, Angus C W Chan, Wan Yee Lau, Itaru Endo, Harumi Gomi, Masahiro Yoshida, Toshihiko Mayumi, Todd H Baron, Eduardo de Santibañes, Anthony Yuen Bun Teoh, Tsann-Long Hwang, Chen-Guo Ker, Miin-Fu Chen, Ho-Seong Han, Yoo-Seok Yoon, In-Seok Choi, Dong-Sup Yoon, Ryota Higuchi, Seigo Kitano, Masafumi Inomata, Daniel J Deziel, Eduard Jonas, Koichi Hirata, Yoshinobu Sumiyama, Kazuo Inui, Masakazu Yamamoto
雑誌名: J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):17-30. doi: 10.1002/jhbp.512. Epub 2018 Jan 5.
Abstract/Text
Although the diagnostic and severity grading criteria on the 2013 Tokyo Guidelines (TG13) are used worldwide as the primary standard for management of acute cholangitis (AC), they need to be validated through implementation and assessment in actual clinical practice. Here, we conduct a systematic review of the literature to validate the TG13 diagnostic and severity grading criteria for AC and propose TG18 criteria. While there is little evidence evaluating the TG13 criteria, they were validated through a large-scale case series study in Japan and Taiwan. Analyzing big data from this study confirmed that the diagnostic rate of AC based on the TG13 diagnostic criteria was higher than that based on the TG07 criteria, and that 30-day mortality in patients with a higher severity based on the TG13 severity grading criteria was significantly higher. Furthermore, a comparison of patients treated with early or urgent biliary drainage versus patients not treated this way showed no difference in 30-day mortality among patients with Grade I or Grade III AC, but significantly lower 30-day mortality in patients with Grade II AC who were treated with early or urgent biliary drainage. This suggests that the TG13 severity grading criteria can be used to identify Grade II patients whose prognoses may be improved through biliary drainage. The TG13 severity grading criteria may therefore be useful as an indicator for biliary drainage as well as a predictive factor when assessing the patient's prognosis. The TG13 diagnostic and severity grading criteria for AC can provide results quickly, are minimally invasive for the patients, and are inexpensive. We recommend that the TG13 criteria be adopted in the TG18 guidelines and used as standard practice in the clinical setting. 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.
© 2018 Japanese Society of Hepato-Biliary-Pancreatic Surgery.
PMID 29032610 J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):17-30. doi: 10.1002/jhbp.512. Epub 2018 Jan 5.
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