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

Takada, Tadahiro; Strasberg, Steven M.; Solomkin, Joseph S.; Pitt, Henry A.; Gomi, Harumi; Yoshida, Masahiro; Mayumi, Toshihiko; Miura, Fumihiko; Gouma, Dirk J.; Garden, O. James; Büchler, Markus W.; Kiriyama, Seiki; Yokoe, Masamichi; Kimura, Yasutoshi; Tsuyuguchi, Toshio; Itoi, Takao; Gabata, Toshifumi; Higuchi, Ryota; Okamoto, Kohji; Hata, Jiro; Murata, Atsuhiko; Kusachi, Shozo; Windsor, John A.; Supe, Avinash; Lee, Sung Gyu; Chen, Xiaoping; Yamashita, Yuichi; Hirata, Koichi; Inui, Kentaro; Sumiyama, Yoshinobu

doi:10.1007/s00534-012-0566-y

Cited by 245 publications

(112 citation statements)

References 16 publications

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“…As a matter of course, taking the results of previous various evaluations about TG07 guidelines [12][13][14][15][16] into the revising process, revised guidelines were published in 2013 as TG13 [17][18][19][20].…”

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confidence: 99%

Descriptive review of acute cholecystitis: Japan‐Taiwan collaborative epidemiological study

Yokoe

Takada

Hwang

et al. 2017

J Hepato Biliary Pancreat

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Background Since the publication of the Tokyo Guidelines (TG13) for the management of acute cholecystitis (AC), multidirectional studies have been published. However, epidemiological research about AC with big data was not projected. The aim of this study was to reveal the actual clinical conditions of AC. Method The study was designed as an international multicenter retrospective study of AC in Japan and Taiwan from 2011 to 2013. The factors investigated comprised data related to demographic, history, physical examinations, laboratory and imaging findings. Based on these data, we investigated the various values of AC, and real situation with respect to severity and treatment. Results A total of 5,459 patients with AC were reviewed. Thirty-day mortality rate was 1.1%. Based on the diagnostic criteria, 4,088 patients had a definite diagnosis and 291 had a suspected diagnosis. According to the severity grading, 939 patients were classified as Grade III, 2,308 as Grade II, and 2,130 as Grade I. Cholecystectomy was performed in total of 4,266 patients and 2,765 patients had laparoscopic cholecystectomy. The main etiologies were gallbladder stones in 4,623 cases. Conclusion This epidemiological study with large population will undoubtedly contribute to establish the best practice for managing AC worldwide.

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confidence: 99%

Descriptive review of acute cholecystitis: Japan‐Taiwan collaborative epidemiological study

Yokoe

Takada

Hwang

et al. 2017

J Hepato Biliary Pancreat

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“…Tokyo Guidelines) razdelimo akutni holecistitis v tri stopnje glede na intenzivnost lokalnega in sistemskega vnetja, klinično sliko in prisotnost prizadetosti drugih organov (12,13). Govorimo o blagem (stopnja 1), zmernem (stopnja 2) in hudem (stopnja 3) akutnem holecistitisu (Tabela 1).…”

Section: Klinična Razdelitevunclassified

“…V laboratorijskih izvidih ugotavljamo pri bolnikih z izraženim Tabela 1: razdelitev akutnega holecistitisa v skladu z japonskimi smernicami (angl. tokyo Guidelines) (13 3. respiracijska insuficienca (razmerje Pao2/Fio2 < 300). 4. renalna insuficienca (oligourija, serumska koncentracija kreatinina > 2 mg/dcl).…”

Section: Klinična Slika In Diagnosticiranjeunclassified

“…V Sloveniji pri obravnavi bolnikov z akutnim holecistitisom upoštevamo WSES in japonske smernice (13)(14)(15). Bolnike z dokazanim akutnim holecistitisom poskušamo čimprej po sprejemu v bolnišnico operirati (22).…”

Section: Kirurško Zdravljenjeunclassified

“…Metaanaliza Indarja in Beckinghama je ugotovila, da je zgodnja laparoskopska holecistektomija akutno vnetega žolčni-ka varna in izvedljiva metoda zdravljenja, še posebej če jo lahko opravimo znotraj 72 ur od nastanka simptomov (16). Tudi posodobljene japonske smernice iz leta 2013 navajajo, da naj bi se zgodnja laparoskopska holecistektomija opravila znotraj 72 ur od nastopa simptomov (13).…”

Section: Izsledki Kliničnih šTudij In Metaanalizunclassified

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Akutno vnetje žolčnika – zgodnja operacija ali poskus konzervativnega zdravljenja?

Janež¹

2018

SlovMedJour

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IzvlečekAkutno vnetje žolčnika oziroma akutni holecistitis je pogosta bolezen, ki večkrat zahteva sprejem v bolnišnico in kirurško zdravljenje. Najpogosteje se pojavlja pri ljudeh, ki imajo žolčne kamne, pojavi pa se lahko tudi v odsotnosti žolčnih kamnov. Diagnozo akutnega holecistitisa postavimo na osnovi klinične slike, laboratorijskih izvidov in ultrazvoka trebuha. Algoritmi za bolnike, ki imajo akutno vnetje žolčnika brez pridruženih bolezni, so znani; odločitev za kirurški poseg pri bolnikih s pridruženimi boleznimi pa je odvisna od več dejavnikov. Laparoskopska holecistektomija je metoda izbire zdravljenja bolnikov z akutnim holecistitisom. Rezultati zdravljenja so bistveno boljši, kadar kirurški poseg napravimo znotraj 72 ur od nastopa kliničnih znakov.V prispevku so predstavljena najnovejša priporočila za obravnavo bolnikov z akutnim holecistitisom, povzeta po smernicah iz Tokia ter smernicah Svetovnega združenja za urgentno kirurgijo iz leta 2016 ter na koncu še izsledki in izkušnje nekaterih kliničnih študij in metaanaliz. AbstractAcute cholecystitis is a common disease, which often requires admission to hospital and surgical treatment. Acute cholecystitis is defined as inflammation of the gallbladder and usually occurs due to cystic duct obstruction from stones or sludge. It is a relatively common complication of gallstones, but it can also occur without gallstones. A combination of relevant clinical symptoms and ultrasound evidence is required to make a diagnosis of acute cholecystitis. Early surgery is recommended for all patients that are in good physical condition. There is still a debate how to treat high-risk and critically ill patients. Laparoscopic cholecystectomy is the method of choice for treatment of patients with acute cholecystitis. Early laparoscopic cholecystectomy should be done within 72 hours from the onset of symptoms. This article presents current guidelines according to the Tokyo guidelines and the World Society of Emergency Surgery guidelines, and at the end, experiences of some clinical trials. UvodAkutno vnetje žolčnika oziroma akutni holecistitis je pogosto bolezen, ki velikokrat zahteva bolnišnično zdravljenje in operacijo. Najpogosteje se pojavlja pri ljudeh z žolčnimi kamni, lahko pa tudi brez njih (1). Vnetje žolčnika brez prisotnosti kamnov je pogostejše pri kritično bolnih, ki so dlje časa na parenteralni prehrani, pri politravmatiziranih bolnikih, pri večjih opeklinah in pri bolnikih po srčnih operacijah (2). Akutni holecistitis je še posebej pogost vzrok

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Meta‐analysis of the cost‐effectiveness of early versus delayed cholecystectomy for acute cholecystitis

2019

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Background: Acute calculous cholecystitis (ACC) is a common disease across the world and is associated with significant socioeconomic costs. Although contemporary guidelines support the role of early laparoscopic cholecystectomy (ELC), there is significant variation among units adopting it as standard practice. There are many resource implications of providing a service whereby cholecystectomies for acute cholecystitis can be performed safely. Methods: Studies that incorporated an economic analysis comparing early with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis were identified by means of a systematic review. A meta-analysis was performed on those cost evaluations. The quality of economic valuations contained therein was evaluated using the Quality of Health Economic Studies (QHES) analysis score. Results: Six studies containing cost analyses were included in the meta-analysis with 1128 patients. The median healthcare cost of ELC versus DLC was €4400 and €6004 respectively. Five studies had adequate data for pooled analysis. The standardized mean difference between ELC and DLC was −2⋅18 (95 per cent c.i. −3⋅86 to −0⋅51; P = 0⋅011; I 2 = 98⋅7 per cent) in favour of ELC. The median QHES score for the included studies was 52⋅17 (range 41-72), indicating overall poor-to-fair quality. Conclusion: Economic evaluations within clinical trials favour ELC for ACC. The limited number and poor quality of economic evaluations are noteworthy.

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

Cited by 245 publications

References 16 publications

Descriptive review of acute cholecystitis: Japan‐Taiwan collaborative epidemiological study

Descriptive review of acute cholecystitis: Japan‐Taiwan collaborative epidemiological study

Akutno vnetje žolčnika – zgodnja operacija ali poskus konzervativnega zdravljenja?

Meta‐analysis of the cost‐effectiveness of early versus delayed cholecystectomy for acute cholecystitis

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