New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo Guidelines

Masamichi Yokoe, Tadahiro Takada, Steven M Strasberg, Joseph S Solomkin, Toshihiko Mayumi, Harumi Gomi, Henry A Pitt, Dirk J Gouma, O James Garden, Markus W Büchler, Seiki Kiriyama, Yasutoshi Kimura, Toshio Tsuyuguchi, Takao Itoi, Masahiro Yoshida, Fumihiko Miura, Yuichi Yamashita, Kohji Okamoto, Toshifumi Gabata, Jiro Hata, Ryota Higuchi, John A Windsor, Philippus C Bornman, Sheung-Tat Fan, Harijt Singh, Eduardo de Santibanes, Shinya Kusachi, Atsuhiko Murata, Xiao-Ping Chen, Palepu Jagannath, Sunggyu Lee, Robert Padbury, Miin-Fu Chen, Tokyo Guidelines Revision Committee, Masamichi Yokoe, Tadahiro Takada, Steven M Strasberg, Joseph S Solomkin, Toshihiko Mayumi, Harumi Gomi, Henry A Pitt, Dirk J Gouma, O James Garden, Markus W Büchler, Seiki Kiriyama, Yasutoshi Kimura, Toshio Tsuyuguchi, Takao Itoi, Masahiro Yoshida, Fumihiko Miura, Yuichi Yamashita, Kohji Okamoto, Toshifumi Gabata, Jiro Hata, Ryota Higuchi, John A Windsor, Philippus C Bornman, Sheung-Tat Fan, Harijt Singh, Eduardo de Santibanes, Shinya Kusachi, Atsuhiko Murata, Xiao-Ping Chen, Palepu Jagannath, Sunggyu Lee, Robert Padbury, Miin-Fu Chen, Tokyo Guidelines Revision Committee

Abstract

Background: The Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) were published in 2007 as the world's first guidelines for acute cholangitis and cholecystitis. The diagnostic criteria and severity assessment of acute cholecystitis have since been widely used all over the world. A validation study of TG07 has shown that the diagnostic criteria for acute cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. In addition, considerable new evidence referring to acute cholecystitis as well as evaluations of TG07 have been published. Consequently, we organized the Tokyo Guidelines Revision Committee to evaluate TG07, recognize new evidence, and conduct a multi-center analysis to revise the guidelines (TG13).

Methods and materials: We retrospectively analyzed 451 patients with acute cholecystitis from multiple tertiary care centers in Japan. All 451 patients were first evaluated using the criteria in TG07. The "gold standard" for acute cholecystitis in this study was a diagnosis by pathology. The validity of TG07 diagnostic criteria was investigated by comparing clinical with pathological diagnosis.

Results: Of 451 patients evaluated, a total of 227 patients were given a diagnosis of acute cholecystitis by pathological examination (prevalence 50.3 %). TG07 criteria provided a definite diagnosis of acute cholecystitis in 224 patients. The sensitivity of TG07 diagnostic criteria for acute cholecystitis was 92.1 %, and the specificity was 93.3 %. Based on the preliminary results, new diagnostic criteria for acute cholecystitis were proposed. Using the new criteria, the sensitivity of definite diagnosis was 91.2 %, and the specificity was 96.9 %. The accuracy rate was improved from 92.7 to 94.0 %. In regard to severity grading among 227 patients, 111 patients were classified as Mild (Grade I), 104 as Moderate (Grade II), and 12 as Severe (Grade III).

Conclusion: The proposed new diagnostic criteria achieved better performance than the diagnostic criteria in TG07. Therefore, the proposed criteria have been adopted as new diagnostic criteria for acute cholecystitis and are referred to as the 2013 Tokyo Guidelines (TG13). Regarding severity assessment, no new evidence was found to suggest that the criteria in TG07 needed major adjustment. As a result, TG07 severity assessment criteria have been adopted in TG13 with minor changes.

Figures

Fig. 1
Fig. 1
Typical US image of acute cholecystitis, demonstrating gallbladder swelling, wall thickening with sonolucent layers, massive debris, and the stone impaction in the cystic duct

References

    1. Strasberg SM. Acute calculous cholecystitis. N Engl J Med 2008; 358: 2804–11.
    1. Eskelinen M, Ikonen J, Lipponen P. Diagnostic approaches in acute cholecystitis; a prospective study of 1333 patients with acute abdominal pain. Theor Surg. 1993;8:15–20.
    1. Halasz NA. Counterfeit cholecystitis, a common diagnostic dilemma. Am J Surg. 1975;130:189–193. doi: 10.1016/0002-9610(75)90369-4.
    1. Johnson H, Jr, Cooper B. The value of HIDA scans in the initial evaluation of patients for cholecystitis. J Natl Med Assoc. 1995;87:27–32.
    1. Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, Mayumi T, Yoshida M, Strasberg S, Pitt H, Gadacz TR, de Santibanes E, Gouma DJ, Solomkin JS, Belghiti J, Neuhaus H, Büchler MW, Fan ST, Ker CG, Padbury RT, Liau KH, Hilvano SC, Belli G, Windsor JA, Dervenis C. Diagnostic criteria and severity assessment of acute cholecystitis: TokyoGuidelines. J Hepatobiliary Pancreat Surg. 2007;14(1):78–82 (Epub 2007 Jan 30).
    1. Yokoe M, Takada T, Mayumi T, Yoshida M, Hasegawa H, Norimizu S, Hayashi K, Umemura S, Orito E. 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;18:250–257. doi: 10.1007/s00534-010-0338-5.
    1. Ralls PW, Colletti PM, Lapin SA, Chandrasoma P, Boswell WD Jr, Ngo C, Radin DR, Halls JM. Real-time sonography in suspected acute cholecystitis. Prospective evaluation of primary and secondary signs. Radiology. 1985; 155(3):767–71.
    1. Hunt DR, Chu FC. Gangrenous cholecystitis in the laparoscopic era. Aust NZ J Surg. 2000;70:428–430. doi: 10.1046/j.1440-1622.2000.01851.x.
    1. Alobaidi M, Gupta R, Jafri SZ, Fink-Bennet DM. Current trends in imaging evaluation of acute cholecystitis. Emerg Radiol. 2004;10:256–258. doi: 10.1007/s10140-004-0325-8.
    1. Rosen Cl, Brown DF, Chang Y, Moore C, Averill NJ, Arkoff LJ, Mccabe CJ, Wolfe RE. Ultrasonography by emergency physicians in patients with suspected cholecystitis. Am J Emerg Med 2001; 19: 32–36.
    1. Kendall JL, Shimp RJ. Performance and interpretation of focused right upper quadrant ultrasound by emergency. J Emerg Med. 2001;21:7–13. doi: 10.1016/S0736-4679(01)00329-8.
    1. Fidler J, Paulson EK, Layfield L. CT evaluation of acute cholecystitis: findings and usefulness in diagnosis. AJR. 1996;166:1085–1088.
    1. Gruber PJ, Silverman RA, Gottesfeld S, Flaster E. Presence of fever and leukocytosis in acute cholecystitis. Ann Emerg Med. 1996;28:273–277. doi: 10.1016/S0196-0644(96)70025-2.
    1. Lee SW, Yang SS, Chang CS, Yeh HJ. Impact of the Tokyo guidelines on the management of patients with acute calculous cholecystitis. J Gastroenterol Hepatol. 2009; 24(12):1857–61 (Epub).
    1. Lee SW, Chang CS, Lee TY, Tung CF, Peng YC. The role of the Tokyo guidelines in the diagnosis of acute calculous cholecystitis. J Hepatobiliary Pancreat Sci. 2010; 17(6): 879–84 (Epub 2010 Apr 24).
    1. Juvonen T, Kiviniemi H, Niemela O, Kairaluoma MI. Diagnostic accuracy of ultrasonography and C reactive protein concentration in acute cholecystitis: a prospective clinical study. Eur J Surg. 1992;158:365–369.
    1. Nguyen L, Fagan SP, Lee TC, Aoki N, Itani KM, Berger DH, Awad SS. Use of a predictive equation for diagnosis of acute gangrenous cholecystitis. Am J Surg. 2004;188(5):463–466. doi: 10.1016/j.amjsurg.2004.07.013.
    1. Contini S, Corradi D, Busi N, Alessandri L, Pezzarossa A, Scarpignato C. Can gangrenous cholecystitis be prevented?: a plea against a “wait and see” attitude. J Clin Gastroenterol. 2004;38(8):710–716. doi: 10.1097/01.mcg.0000135898.68155.88.
    1. Girgin S, Gedik E, Taçyildiz IH, Akgün Y, Baç B, Uysal E. Factors affecting morbidity and mortality in gangrenous cholecystitis. Acta Chir Belg. 2006; 106(5):545–9.
    1. Fagan SP, Awad SS, Rahwan K, Hira K, Aoki N, Itani KM, Berger DH. Prognostic factors for the development of gangrenous cholecystitis. Am J Surg. 2003;186(5):481–485. doi: 10.1016/j.amjsurg.2003.08.001.
    1. Aydin C, Altaca G, Berber I, Tekin K, Kara M, Titiz I. Prognostic parameters for the prediction of acute gangrenous cholecystitis. J Hepatobiliary Pancreat Surg. 2006;13(2):155–159. doi: 10.1007/s00534-005-1042-8.
    1. Yacoub WN, Petrosyan M, Sehgal I, Ma Y, Chandrasoma P, Mason RJ. Prediction of patients with acute cholecystitis requiring emergent cholecystectomy: a simple score. Gastroenterol Res Pract. 2010; 2010:901739 (Epub 2010 Jun 8).
    1. Wang AJ, Wang TE, Lin CC, Lin SC, Shih SC. Clinical predictors of severe gallbladder complications in acute acalculous cholecystitis. World J Gastroenterol. 2003;9(12):2821–2823.
    1. McChesney JA, Northup PG, Bickston SJ. Acute acalculous cholecystitis associated with systemic sepsis and visceral arterial hypoperfusion: a case series and review of pathophysiology. Dig Dis Sci. 2003;48(10):1960–1967. doi: 10.1023/A:1026118320460.
    1. Young AL, Cockbain AJ, White AW, Hood A, Menon KV, Toogood GJ. Index admission laparoscopic cholecystectomy for patients with acute biliary symptoms: results from a specialist centre. HPB (Oxford) 2010;12(4):270–276.
    1. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707–710. doi: 10.1007/BF01709751.
    1. Mayumi T, Takada T, Kawarada Y, Nimura Y, Yoshida M, Sekimoto M, et al. Results of the Tokyo Consensus Meeting Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:114–121. doi: 10.1007/s00534-006-1163-8.
    1. Trowbridge RL, Rutkowski NK, Shojania KG. Does this patient have acute cholecystitis? JAMA. 2003;289:80–86. doi: 10.1001/jama.289.1.80.
    1. Weiss CA, III, Schwartz RW. Current diagnosis and treatment of cholecystitis. Curr Surg. 2002;59:51–54. doi: 10.1016/S0149-7944(01)00628-6.
    1. Asai K, Watanabe M, Kusachi S, Tanaka H, Matsukiyo H, Osawa A, Saito T, Kodama H, Enomoto T, Nakamura Y, Okamoto Y, Saida Y, Nagao J. Bacteriological analysis of bile in acute cholecystitis according to the Tokyo guidelines. J Hepatobiliary Pancreat Sci. 2011 (Epub ahead of print).

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