Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines
Open Access
- 30 January 2007
- journal article
- practice guideline
- Published by Springer Science and Business Media LLC in Journal of Hepato-Biliary-Pancreatic Surgery
- Vol. 14 (1), 27-34
- https://doi.org/10.1007/s00534-006-1153-x
Abstract
Diagnostic and therapeutic strategies for acute biliary inflammation/infection (acute cholangitis and acute cholecystitis), according to severity grade, have not yet been established in the world. Therefore we formulated flowcharts for the management of acute biliary inflammation/infection in accordance with severity grade. For mild (grade I) acute cholangitis, medical treatment may be sufficient/appropriate. For moderate (grade II) acute cholangitis, early biliary drainage should be performed. For severe (grade III) acute cholangitis, appropriate organ support such as ventilatory/circulatory management is required. After hemodynamic stabilization is achieved, urgent endoscopic or percutaneous transhepatic biliary drainage should be performed. For patients with acute cholangitis of any grade of severity, treatment for the underlying etiology, including endoscopic, percutaneous, or surgical treatment should be performed after the patient’s general condition has improved. For patients with mild (grade I) cholecystitis, early laparoscopic cholecystectomy is the preferred treatment. For patients with moderate (grade II) acute cholecystitis, early laparoscopic or open cholecystectomy is preferred. In patients with extensive local inflammation, elective cholecystectomy is recommended after initial management with percutaneous gallbladder drainage and/or cholecystostomy. For the patient with severe (grade III) acute cholecystitis, multiorgan support is a critical part of management. Biliary peritonitis due to perforation of the gallbladder is an indication for urgent cholecystectomy and/or drainage. Delayed elective cholecystectomy may be performed after initial treatment with gallbladder drainage and improvement of the patient’s general medical condition.Keywords
This publication has 19 references indexed in Scilit:
- Color velocity imaging and power Doppler sonography of the gallbladder wall: a new look at sonographic diagnosis of acute cholecystitis.American Journal of Roentgenology, 1998
- Predictors of common bile duct stones prior to cholecystectomy: a meta-analysisGastrointestinal Endoscopy, 1996
- Gallstones in critically ill patients with acute calculous cholecystitis treated by percutaneous cholecystostomy: nonsurgical therapeutic options.American Journal of Roentgenology, 1994
- Percutaneous transhepatic cholecystostomy for acute acalculous cholecystitisBritish Journal of Surgery, 1993
- Risk factors and classification of acute suppurative cholangitisBritish Journal of Surgery, 1992
- Endoscopic Biliary Drainage for Severe Acute CholangitisThe New England Journal of Medicine, 1992
- Prospective evaluation of the sonographic murphy sign in suspected acute cholecystitisJournal of Clinical Ultrasound, 1982
- The urgency of diagnosis and surgical treatment of acute suppurative cholangitisThe American Journal of Surgery, 1976
- Clinical Presentation of Acute Abdomen: Study of 600 PatientsBMJ, 1972
- Acute Obstructive Cholangitis A Distinct Clinical SyndromeAnnals of Surgery, 1959