The Yield of Fever, Inflammatory Markers and Ultrasound in the Diagnosis of Acute Cholecystitis: A Validation of the 2013 Tokyo Guidelines

Naidu, Krishanth; Beenen, Edwin; Gananadha, Sivakumar; Mosse, Charles A.

doi:10.1007/s00268-016-3660-5

Cited by 33 publications

(13 citation statements)

References 22 publications

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“…However, the latter study found that neutrophil count was the only independent predictor of acute cholecystitis for which a significant difference was evident on the basis of multivariate analysis . The use of neutrophil count alone for the definitive diagnosis of acute cholecystitis is unrealistic.…”

Section: Introductionmentioning

confidence: 94%

“…To date, no diagnostic criteria for acute cholecystitis meriting that title have been established other than TG13 . However, studies of the diagnostic yield of the TG13 diagnostic criteria are limited .…”

Section: Introductionmentioning

confidence: 99%

“…Studies have found that diagnostic accuracy ranges from 94.0% to 60.4% if pathological samples are used as the gold standard. In the former study, the sensitivity and specificity of the diagnostic criteria for acute cholecystitis were 91.2% and 96.9%, compared with 83.1% and 37.5% in the latter study.…”

Section: Introductionmentioning

confidence: 99%

“…The use of US in acute cholecystitis has been well reported, and its ease of use and non‐invasive modality have been described in case series studies . However, the diagnostic yield described in those articles varies according to the device, assessment criteria, and diagnostic criteria used in each of the studies, all of which were of small numbers of patients in single institutions.…”

Section: Introductionmentioning

confidence: 99%

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

Yokoe

Hata

Takada

et al. 2018

J Hepato Biliary Pancreat

939

605

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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 1 st 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.

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Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Yokoe

Hata

Takada

et al. 2018

J Hepato Biliary Pancreat

939

605

View full text Add to dashboard Cite

show abstract

“…The majority of the patients are asymptomatic, and approximately 20% of symptomatic patients present with acute cholecystitis (AC). 1 …”

Section: Introductionmentioning

confidence: 99%

Can we predict severity of acute cholecystitis at admission?

Er¹,

Özden²,

Çelik³

et al. 2018

Pak J Med Sci

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Background and Objective:Acute cholecystitis (AC) is an inflammation of the gallbladder. Tokyo Guidelines (TGs) for the diagnosis of AC classified this condition according to severity as mild, moderate and severe. Therapeutic intervention regulated according to the type of severity. This study aimed to determine laboratory parameters that predict the severity of AC at hospital admission.Methods:One-hundred and ten patients with AC were retrospectively reviewed. These patients were treated in our department of surgery within a one-year period (2015–2016). Three patient groups were formed depending on the severity of Acute cholecystitis.Results:The baseline mean values for white blood cell count (WBC), blood urea nitrogen (BUN), creatinine and international normalized ratio (INR) were higher in the severe patient group at a significant level compared to the mild patient group. The WBC level was also significantly higher in the moderate group than the mild group. However, none of the laboratory parameters differentiated the severe group from the moderate group.Conclusion:Acute cholecystitis patients with high WBC, BUN, creatinine and INR levels at admission should be referred to an advanced care center for management.

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Acute Cholecystitis

Gallaher

Charles

2022

JAMA

213

125

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cute cholecystitis is an acute inflammatory disease of the gallbladder that is caused by gallstone obstruction of the cystic duct in approximately 90% to 95% of people diagnosed with this condition. 1 Less commonly, acalculous cholecystitis, in which acute inflammation of the gallbladder develops without gallstones, is present in approximately 5% to 10% of people diagnosed with acute cholecystitis.Gallbladder disease affects approximately 20 million individuals in the US and results in estimated direct annual costs of more than $6.3 billion, with more than 200 000 people diagnosed with acute cholecystitis each year. [2][3][4] Of the 10% to 15% of adults in the US general population with cholelithiasis, approximately 80% are asymptomatic. 5 Twenty percent of patients with gallstones will eventually develop gallstone-related complications at an incidence rate of 1% to 4% annually, with calculous acute cholecystitis as the first clinical presentation in 10% to 15% of all patients with gallstones. 6 In contrast, the etiology of acalculous acute cholecystitis, defined as an acute inflammatory disease of the gallbladder in the absence of cholelithiasis, is multifactorial. Factors associated with acalculous acute cholecystitis include critical illness, diabetes, HIV infection, atherosclerosis, and total parenteral nutrition. 7,8 Acalculous acute cholecystitis is present in approximately 5% to 10% of patients presenting with acute cholecystitis. Acalculous IMPORTANCE Gallbladder disease affects approximately 20 million people in the US. Acute cholecystitis is diagnosed in approximately 200 000 people in the US each year.OBSERVATIONS Gallstone-associated cystic duct obstruction is responsible for 90% to 95% of the cases of acute cholecystitis. Approximately 5% to 10% of patients with acute cholecystitis have acalculous cholecystitis, defined as acute inflammation of the gallbladder without gallstones, typically in the setting of severe critical illness. The typical presentation of acute cholecystitis consists of acute right upper quadrant pain, fever, and nausea that may be associated with eating and physical examination findings of right upper quadrant tenderness. Ultrasonography of the right upper quadrant has a sensitivity of approximately 81% and a specificity of approximately 83% for the diagnosis of acute cholecystitis. When an ultrasound result does not provide a definitive diagnosis, hepatobiliary scintigraphy (a nuclear medicine study that includes the intravenous injection of a radiotracer excreted in the bile) is the gold standard diagnostic test. Following diagnosis, early (performed within 1-3 days) vs late (performed after 3 days) laparoscopic cholecystectomy is associated with improved patient outcomes, including fewer composite postoperative complications (11.8% for early vs 34.4% for late), a shorter length of hospital stay (5.4 days vs 10.0 days), and lower hospital costs. During pregnancy, early laparoscopic cholecystectomy, compared with delayed operative management, is associated with a lower risk of ...

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The Yield of Fever, Inflammatory Markers and Ultrasound in the Diagnosis of Acute Cholecystitis: A Validation of the 2013 Tokyo Guidelines

Abstract: The 2013 Tokyo Guidelines were slightly better in predicting acute cholecystitis but over diagnosed two-thirds of normal gallbladders compared to neutrophil count alone.

Cited by 33 publications

References 22 publications

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

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

Can we predict severity of acute cholecystitis at admission?

Acute Cholecystitis

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