title: Background: Tokyo Guidelines for the management of acute cholangitis and cholecystitis.
abstract: There are no evidence-based-criteria for the diagnosis, severity assessment, of treatment of acute cholecystitis 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.
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Takada
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Kawarada
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nimura
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Mayumi
authors.forename: Miho
authors.initials: M
authors.lastname: Sekimoto
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miura
authors.forename: Keita
authors.initials: K
authors.lastname: Wada
authors.forename: Masahiko
authors.initials: M
authors.lastname: Hirota
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
authors.forename: Toshio
authors.initials: T
authors.lastname: Tsuyuguchi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tanaka
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Kimura
authors.forename: Hideki
authors.initials: H
authors.lastname: Yasuda
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.forename: Steven M
authors.initials: SM
authors.lastname: Strasberg
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Gadacz
authors.forename: Philippus C
authors.initials: PC
authors.lastname: Bornman
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: Giulio
authors.initials: G
authors.lastname: Belli
authors.forename: Kui-Hin
authors.initials: KH
authors.lastname: Liau
mesh_terms: D000208:Acute Disease; D002761:Cholangitis / Q000175:diagnosis / Q000628:therapy*; D041881:Cholecystitis, Acute / Q000175:diagnosis / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic; D012107:Research Design; D014041:Tokyo