Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines.
Because acute cholangitis sometimes rapidly progresses to a severe form accompanied by organ dysfunction, caused by the systemic inflammatory response syndrome (SIRS) and/or sepsis, prompt diagnosis and severity assessment are necessary for appropriate management, including intensive care with organ support and urgent biliary drainage in addition to medical treatment. However, because there have been no standard criteria for the diagnosis and severity assessment of acute cholangitis, practical clinical guidelines have never been established. The aim of this part of the Tokyo Guidelines is to propose new criteria for the diagnosis and severity assessment of acute cholangitis based on a systematic review of the literature and the consensus of experts reached at the International Consensus Meeting held in Tokyo 2006. Acute cholangitis can be diagnosed if the clinical manifestations of Charcot's triad, i.e., fever and/or chills, abdominal pain (right upper quadrant or epigastric), and jaundice are present. When not all of the components of the triad are present, then a definite diagnosis can be made if laboratory data and imaging findings supporting the evidence of inflammation and biliary obstruction are obtained. The severity of acute cholangitis can be classified into three grades, mild (grade I), moderate (grade II), and severe (grade III), on the basis of two clinical factors, the onset of organ dysfunction and the response to the initial medical treatment. "Severe (grade III)" acute cholangitis is defined as acute cholangitis accompanied by at least one new-onset organ dysfunction. "Moderate (grade II)" acute cholangitis is defined as acute cholangitis that is unaccompanied by organ dysfunction, but that does not respond to the initial medical treatment, with the clinical manifestations and/or laboratory data not improved. "Mild (grade I)" acute cholangitis is defined as acute cholangitis that responds to the initial medical treatment, with the clinical findings improved.
Wada
Keita
K
Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
Takada
Tadahiro
T
Kawarada
Yoshifumi
Y
Nimura
Yuji
Y
Miura
Fumihiko
F
Yoshida
Masahiro
M
Mayumi
Toshihiko
T
Strasberg
Steven
S
Pitt
Henry A
HA
Gadacz
Thomas R
TR
Büchler
Markus W
MW
Belghiti
Jacques
J
de Santibanes
Eduardo
E
Gouma
Dirk J
DJ
Neuhaus
Horst
H
Dervenis
Christos
C
Fan
Sheung-Tat
ST
Chen
Miin-Fu
MF
Ker
Chen-Guo
CG
Bornman
Philippus C
PC
Hilvano
Serafin C
SC
Kim
Sun-Whe
SW
Liau
Kui-Hin
KH
Kim
Myung-Hwan
MH
D000208:Acute Disease; D002761:Cholangitis / Q000097:blood / Q000145:classification / Q000175:diagnosis*; D006801:Humans; D011379:Prognosis; D012720:Severity of Illness Index