Dear Editor,

We read with great interest the article titled “Admission after the gold interval in acute calculous cholecystitis: Should we really cool it off?” by Bozkurt et al. [1]. The authors retrospectively reviewed and compared treatment outcomes of patients with acute cholecystitis who had early or late cholecystectomy. How did the authors identify which patients to send to surgery? Do they have a standard algorithm? The methodology of directing patients in each treatment arm is poorly defined.

The authors are not mentioning Tokyo guidelines [2] at all which actually outlines and standardizes management of acute cholecystitis in a step-by-step manner. The latest update of Tokyo guidelines is the 13th version and it evaluates systemic inflammation, cholestasis, imaging findings. Sensitivity and specificity of the 13th version reaches 91.8 and 77.7% [3]. Authors could also have analysed if their previous management scheme would resulted differently if they had followed Tokyo guidelines. This would be a valuable external validation of the Tokyo guidelines in a different population.