Verification of the Tokyo guidelines for acute cholangitis secondary to benign and malignant biliary obstruction: experience from a Chinese tertiary hospital.
BACKGROUND
The lack of widely-accepted guidelines for acute cholangitis largely lags behind the progress in medical and surgical technology and science for the management of acute cholangitis. This study aimed to verify the Tokyo guidelines for the management of acute cholangitis and cholecystitis of 2007 edition (TG07) in patients with obstructive cholangitis due to benign and malignant diseases.


METHODS
The patients were retrieved from our existing ERCP database. Final diagnosis of acute cholangitis was made by detecting purulent bile during biliary drainage. We examined and compared the guidelines concerning benign and malignant obstruction.


RESULTS
In 120 patients in our study, 82 and 38 had benign and malignant biliary obstruction, respectively. Guidelines based diagnosis was made in 68 (82.9%), 36 (94.7%), and 104 (86.7%) patients with benign, malignant, and overall biliary obstruction, respectively, which were significantly higher than 44 (53.7%), 17 (44.7%), and 61 (50.8%) diagnosed by Charcot's triad (P<0.001). Treatment consistent with the guidelines was offered to 58 (70.7%) patients with benign obstruction and 15 (39.5%) patients with malignant obstruction (P=0.001). No significant association was observed between clinical compliance, guidelines-based severity grades and clinical outcomes. In the multivariate model, intrahepatic obstruction (OR=11.2, 95% CI: 1.55-226.9) and hypoalbuminemia (≤25.0 g/L; OR=17.3, 95% CI: 3.5-313.6) were independent risk factors for a 30-day mortality.


CONCLUSIONS
The TG07 are more reliable than Charcot's triad for the diagnosis of acute cholangitis albeit with limited prognostic values. Intrahepatic obstruction and hypoalbuminemia are new predictors of poor prognosis and need further assessment.
Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China.
Gang
G
Sun
Lu
L
Han
Yun-Sheng
YS
Yang
En-Qiang
EQ
Linghu
Wen
W
Li
Feng-Chun
FC
Cai
Jin-Yan
JY
Kong
Xiang-Dong
XD
Wang
Jiang-Yun
JY
Meng
Hong
H
Du
Hong-Bin
HB
Wang
Qi-Yang
QY
Huang
Quratulain
Q
Hyder
Xiu-Li
XL
Zhang
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000150:complications*; D002681:China; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D002779:Cholestasis / Q000150:complications* / Q000209:etiology; D004322:Drainage; D005260:Female; D042882:Gallstones / Q000150:complications*; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012720:Severity of Illness Index; D062606:Tertiary Care Centers