1887
Volume 2022, Issue 4
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Acute cholangitis (AC) is a life-threatening condition with a mortality risk of 8%–10%. Despite no gold standard for diagnosis, Charcot's triad was introduced to diagnose AC. However, the triad had a low sensitivity (50%–70%). Recently, Tokyo guidelines (TG) for the diagnosis of AC gained international recognition for their excellent diagnostic rate. In this study, we aimed to apply TG18 guidelines in a retrospective manner to diagnose AC in Qatar to validate TG18. This retrospective observational study recruited 295 patients with clinically proven AC between January 2016 and July 2018. Of the 213 patients, 72.2% were men. The mean age was 51.4 ± 17.5 years. The most common co-morbidity was hypertension (36.3%). Common bile duct stones were the most common cause of biliary obstruction found in 165 (55.9%) patients. The diagnostic rate of TG18 was 91.9% in contrast to Charcot's triad (34.9%). By TG18 grading, 150 (50.8%) patients were grade I. ERCP was done in 62% patients, and 52.5% of them were grade I. AC management in Qatar meets the international standards with a low mortality rate. TG18 guidelines had a high diagnostic rate among our patient population.

Loading

Article metrics loading...

/content/journals/10.5339/jemtac.2022.17
2022-07-18
2022-08-10
Loading full text...

Full text loading...

/deliver/fulltext/jemtac/2022/4/jemtac.2022.17.html?itemId=/content/journals/10.5339/jemtac.2022.17&mimeType=html&fmt=ahah

References

  1. Mayumi T, Someya K, Ootubo H, Takama T, Kido T, Kamezaki F, et al. Progression of Tokyo guidelines and Japanese guidelines for management of acute cholangitis and cholecystitis. J UOEH. 2013;:35:249–57. doi: 10.7888/juoeh.35.249.
    [Google Scholar]
  2. Tsujino T, Sugita R, Yoshida H, Yagioka H, Kogure H, Sasaki T, et al. Risk factors for acute suppurative cholangitis caused by bile duct stones. Eur J Gastroenterol Hepatol. 2007;:19:585–8. doi:10.1097/MEG.0b013e3281532b78.
    [Google Scholar]
  3. Lee SP, Roberts JR, Kuver R. The changing faces of cholangitis. F1000Res. 2016: Jun;5:F1000. doi: 10.12688/f1000research.8745.1. PMID: 27347393; PMCID: PMC4916985.
    [Google Scholar]
  4. Karvellas CJ, Abraldes JG, Zepeda-Gomez S, Moffat DC, Mirzanejad Y, Vazquez-Grande G, et al. Cooperative Antimicrobial Therapy of Septic Shock Database Research Group. The impact of delayed biliary decompression and anti-microbial therapy in 260 patients with cholangitis-associated septic shock. Aliment Pharmacol Ther. 2016;:44:755–66. doi: 10.1111/apt.13764.
    [Google Scholar]
  5. Mosler P. Diagnosis and management of acute cholangitis. Curr Gastroenterol Rep. 2011: Apr; 13:(2):166–72. doi: 10.1007/s11894-010-0171-7. PMID: 21207254.
    [Google Scholar]
  6. Charcot J-M. Lessons on diseases of the liver, bile ducts and kidneys given at the Faculty of Medicine of Paris. Paris: Bourneville and Sevestre, Progres Medical & Adrian Delahaye; 1877.
    [Google Scholar]
  7. Kiriyama S, Takada T, Hwang TL, Akazawa K, Miura F, Gomi H, et al. Clinical application and verification of the TG13 diagnostic and severity grading criteria for acute cholangitis: an international multicenter observational study. J Hepatobiliary Pancreat Sci. 2017 Jun; 24:(6):329–37. doi: 10.1002/jhbp.458. Epub 2017 May 29. PMID: 28419764.
    [Google Scholar]
  8. Csendes A, Diaz JC, Burdiles P, Maluenda F, Morales E. Risk factors and classification of acute suppurative cholangitis. Br J Surg. 1992 Jul; 79:(7):655–8. doi: 10.1002/bjs.1800790720. PMID: 1643478.
    [Google Scholar]
  9. Ely R, Long B, Koyfman A. The emergency medicine-focused review of cholangitis. J Emerg Med. 2018 Jan; 54:(1):64–72. doi: 10.1016/j.jemermed.2017.06.039. PMID: 28939398.
    [Google Scholar]
  10. Kiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA, et al. Tokyo Guidelines Revision Committee. New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo Guidelines. J Hepatobiliary Pancreat Sci. 2012 Sep; 19:(5):548–56. doi: 10.1007/s00534-012-0537-3. PMID: 22825491; PMCID: PMC3429782.
    [Google Scholar]
  11. Gigot JF, Leese T, Dereme T, Coutinho J, Castaing D, Bismuth H. Acute cholangitis. Multivariate analysis of risk factors. Ann Surg. 1989 Apr; 209:(4):435–8. doi: 10.1097/00000658-198904000-00008. PMID: 2930289; PMCID: PMC1493983.
    [Google Scholar]
  12. Zimmer V, Lammert F. Acute Bacterial Cholangitis. Viszeralmedizin. 2015 Jun; 31:(3):166–72. doi: 10.1159/000430965. PMID: 26468310; PMCID: PMC4569195.
    [Google Scholar]
  13. Wada K, Takada T, Kawarada Y, Nimura Y, Miura F, Yoshida M, et al. Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007; 14:(1):52–8. doi: 10.1007/s00534-006-1156-7.
    [Google Scholar]
  14. Kiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA, et al. Tokyo Guidelines Revision Committee. TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2013 Jan; 20:(1):24–34. doi: 10.1007/s00534-012-0561-3. PMID: 23307001.
    [Google Scholar]
  15. Yokoe M, Takada T, Mayumi T, Yoshida M, Hasegawa H, Norimizu S, et al. Accuracy of the Tokyo Guidelines for the diagnosis of acute cholangitis and cholecystitis taking into consideration the clinical practice pattern in Japan. J Hepatobiliary Pancreat Sci. 2011 Mar; 18:(2):250–7. doi: 10.1007/s00534-010-0338-5. PMID: 21042814.
    [Google Scholar]
  16. Fujii Y, Ohuchida J, Chijiiwa K, Yano K, Imamura N, Nagano M, et al. Verification of Tokyo Guidelines for diagnosis and management of acute cholangitis. J Hepatobiliary Pancreat Sci. 2012 Jul; 19:(4):487–91. doi: 10.1007/s00534-011-0464-8. PMID: 22033865.
    [Google Scholar]
  17. Takada T, Strasberg SM, Solomkin JS, Pitt HA, Gomi H, Yoshida M, et al. Tokyo Guidelines Revision Committee. TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013 Jan; 20:(1):1–7. doi: 10.1007/s00534-012-0566-y. PMID: 23307006.
    [Google Scholar]
  18. Sun G, Han L, Yang YS, Linghu EQ, Li W, Cai FC, et al. Verification of the Tokyo guidelines for acute cholangitis secondary to benign and malignant biliary obstruction: experience from a Chinese tertiary hospital. Hepatobiliary Pancreat Dis Int. 2013 Aug; 12:(4):400–7. doi: 10.1016/s1499-3872(13)60062-4. PMID: 23924498.
    [Google Scholar]
  19. Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018 Jan; 25:(1):41–54. doi: 10.1002/jhbp.515. PMID: 29032636.
    [Google Scholar]
  20. Gravito-Soares E, Gravito-Soares M, Gomes D, Almeida N, Tomé L. Clinical applicability of Tokyo guidelines 2018/2013 in diagnosis and severity evaluation of acute cholangitis and determination of a new severity model. Scand J Gastroenterol. 2018 Mar; 53:(3):329–34. doi: 10.1080/00365521.2018.1430255. PMID: 29374984.
    [Google Scholar]
  21. Sun G, Han L, Yang Y, Linghu E, Li W, Cai F, et al. Comparison of two editions of Tokyo guidelines for the management of acute cholangitis. J Hepatobiliary Pancreat Sci. 2014 Feb; 21:(2):113–9. doi: 10.1002/jhbp.9. PMID: 23813895.
    [Google Scholar]
  22. Wah DLC, Christophi C, Muralidharan V. Acute cholangitis: current concepts. ANZ J Surg. 2017 Jul; 87:(7–8):554–9. doi: 10.1111/ans.13981. PMID: 28337833.
    [Google Scholar]
  23. Nishino T, Hamano T, Mitsunaga Y, Shirato I, Shirato M, Tagata T, et al. Clinical evaluation of the Tokyo Guidelines 2013 for severity assessment of acute cholangitis. J Hepatobiliary Pancreat Sci. 2014 Dec; 21:(12):841–9. doi: 10.1002/jhbp.189. PMID: 25410528.
    [Google Scholar]
  24. Salek J, Livote E, Sideridis K, Bank S. Analysis of risk factors predictive of early mortality and urgent ERCP in acute cholangitis. J Clin Gastroenterol. 2009 Feb; 43:(2):171–5. doi: 10.1097/MCG.0b013e318157c62c. PMID: 18769362.
    [Google Scholar]
  25. Lai EC, Tam PC, Paterson IA, Ng MM, Fan ST, Choi TK, et al. Emergency surgery for severe acute cholangitis. The high-risk patients. Ann Surg. 1990 Jan; 211:(1):55–9. doi: 10.1097/00000658-199001000-00009. PMID: 2294844; PMCID: PMC1357893.
    [Google Scholar]
  26. Lipsett PA, Pitt HA. Acute cholangitis. Front Biosci. 2003 Sep;8:s1229–39. doi: 10.2741/88110.2741/88110.2741/88110.2741/881. PMID: 12957832.
    [Google Scholar]
  27. Zhang WZ, Chen YS, Wang JW, Chen XR. Early diagnosis and treatment of severe acute cholangitis. World J Gastroenterol. 2002 Feb; 8:(1):150–2. doi: 10.3748/wjg.v8.i1.150. PMID: 11833092; PMCID: PMC4656608.
    [Google Scholar]
  28. Andrew DJ, Johnson SE. Acute suppurative cholangitis, a medical and surgical emergency. A review of ten years’ experience emphasizing early recognition. Am J Gastroenterol. 1970 Aug; 54:(2):141–54. PMID: 5458220.
    [Google Scholar]
  29. Buyukasik K, Toros AB, Bektas H, Ari A, Deniz MM. Diagnostic and therapeutic value of ERCP in acute cholangitis. ISRN Gastroenterol. 2013 Aug 13;:2013:191729. doi: 10.1155/2013/191729. PMID: 23997958; PMCID: PMC3753744.
    [Google Scholar]
  30. Suwa Y, Matsuyama R, Goto K, Kadokura T, Sato M, Mori R, et al. IL–7 and procalcitonin are useful biomarkers in the comprehensive evaluation of the severity of acute cholangitis. J Hepatobiliary Pancreat Sci. 2017 Feb; 24:(2):81–8. doi: 10.1002/jhbp.420. PMID: 28002647.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/jemtac.2022.17
Loading
/content/journals/10.5339/jemtac.2022.17
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error