Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis

Fumihiko Miura, Kohji Okamoto, Tadahiro Takada, Steven M. Strasberg, Horacio J. Asbun, Henry A. Pitt, Harumi Gomi, Joseph S. Solomkin, David Schlossberg, Ho Seong Han, Myung Hwan Kim, Tsann Long Hwang, Miin Fu Chen, Wayne Shih Wei Huang, Seiki Kiriyama, Takao Itoi, O. James Garden, Kui Hin Liau, Akihiko Horiguchi, Keng Hao LiuCheng Hsi Su, Dirk J. Gouma, Giulio Belli, Christos Dervenis, Palepu Jagannath, Angus C.W. Chan, Wan Yee Lau, Itaru Endo, Kenji Suzuki, Yoo Seok Yoon, Eduardo de Santibañes, Mariano Eduardo Giménez, Eduard Jonas, Harjit Singh, Goro Honda, Koji Asai, Yasuhisa Mori, Keita Wada, Ryota Higuchi, Manabu Watanabe, Toshiki Rikiyama, Naohiro Sata, Nobuyasu Kano, Akiko Umezawa, Shuntaro Mukai, Hiromi Tokumura, Jiro Hata, Kazuto Kozaka, Yukio Iwashita, Taizo Hibi, Masamichi Yokoe, Taizo Kimura, Seigo Kitano, Masafumi Inomata, Koichi Hirata, Yoshinobu Sumiyama, Kazuo Inui, Masakazu Yamamoto

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

The initial management of patients with suspected acute biliary infection starts with the measurement of vital signs to assess whether or not the situation is urgent. If the case is judged to be urgent, initial medical treatment should be started immediately including respiratory/circulatory management if required, without waiting for a definitive diagnosis. The patient's medical history is then taken; an abdominal examination is performed; blood tests, urinalysis, and diagnostic imaging are carried out; and a diagnosis is made using the diagnostic criteria for cholangitis/cholecystitis. Once the diagnosis has been confirmed, initial medical treatment should be started immediately, severity should be assessed according to the severity grading criteria for acute cholangitis/cholecystitis, and the patient's general status should be evaluated. For mild acute cholangitis, in most cases initial treatment including antibiotics is sufficient, and most patients do not require biliary drainage. However, biliary drainage should be considered if a patient does not respond to initial treatment. For moderate acute cholangitis, early endoscopic or percutaneous transhepatic biliary drainage is indicated. If the underlying etiology requires treatment, this should be provided after the patient's general condition has improved; endoscopic sphincterotomy and subsequent choledocholithotomy may be performed together with biliary drainage. For severe acute cholangitis, appropriate respiratory/circulatory management is required. Biliary drainage should be performed as soon as possible after the patient's general condition has been improved by initial treatment and respiratory/circulatory management. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

Original languageEnglish
Pages (from-to)31-40
Number of pages10
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Volume25
Issue number1
DOIs
Publication statusPublished - Jan 2018

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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    Miura, F., Okamoto, K., Takada, T., Strasberg, S. M., Asbun, H. J., Pitt, H. A., Gomi, H., Solomkin, J. S., Schlossberg, D., Han, H. S., Kim, M. H., Hwang, T. L., Chen, M. F., Huang, W. S. W., Kiriyama, S., Itoi, T., Garden, O. J., Liau, K. H., Horiguchi, A., ... Yamamoto, M. (2018). Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. Journal of Hepato-Biliary-Pancreatic Sciences, 25(1), 31-40. https://doi.org/10.1002/jhbp.509